Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

Abstract

The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI)‡Authors/Task Force Members, William Wijns, (Chairperson) (Belgium)*, Philippe Kolh, (Chairperson) (Belgium)*, Nicolas Danchin, (France), Carlo Di Mario, (UK), Volkmar Falk, (Switzerland), Thierry Folliguet, (France), Scot Garg, (The Netherlands), Kurt Huber, (Austria), Stefan James, (Sweden), Juhani Knuuti, (Finland), Jose Lopez-Sendon, (Spain), Jean Marco, (France), Lorenzo Menicanti, (Italy), Miodrag Ostojic, (Serbia), Massimo F. Piepoli, (Italy), Charles Pirlet, (Belgium), Jose L. Pomar, (Spain), Nicolaus Reifart, (Germany), Flavio L. Ribichini, (Italy), Martin J. Schalij, (The Netherlands), Paul Sergeant, (Belgium), Patrick W. Serruys, (The Netherlands), Sigmund Silber, (Germany), Miguel Sousa Uva, (Portugal) and David Taggart, (UK)*Corresponding authors (the two chairpersons contributed equally to this document): William Wijns, Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium. Tel: +32 53 724 439, Fax: +32 53 724 185, Email: william.wijns{at}olvz-aalst.bePhilippe Kolh, Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liege, Sart Tilman B 35, 4000 Liege, Belgium. Tel: +32 4 366 7163, Fax: +32 4 366 7164, Email: philippe.kolh{at}chu.ulg.ac.be The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.ESC Committee for Practice Guidelines, Alec Vahanian, (Chairperson) (France), Angelo Auricchio, (Switzerland), Jeroen Bax, (The Netherlands), Claudio Ceconi, (Italy), Veronica Dean, (France), Gerasimos Filippatos, (Greece), Christian Funck-Brentano, (France), Richard Hobbs, (UK), Peter Kearney, (Ireland), Theresa McDonagh, (UK), Bogdan A. Popescu, (Romania), Zeljko Reiner, (Croatia), Udo Sechtem, (Germany), Per Anton Sirnes, (Norway), Michal Tendera, (Poland), Panos E. Vardas, (Greece) and Petr Widimsky, (Czech Republic)EACTS Clinical Guidelines Committee, Philippe Kolh, (Chairperson) (Belgium), Ottavio Alfieri, (Italy), Joel Dunning, (UK), Stefano Elia, (Italy), Pieter Kappetein, (The Netherlands), Ulf Lockowandt, (Sweden), George Sarris, (Greece) and Pascal Vouhe, (France)Document Reviewers, Peter Kearney, (ESC CPG Review Coordinator) (Ireland), Ludwig von Segesser, (EACTS Review Coordinator) (Switzerland), Stefan Agewall, (Norway), Alexander Aladashvili, (Georgia), Dimitrios Alexopoulos, (Greece), Manuel J. Antunes, (Portugal), Enver Atalar, (Turkey), Aart Brutel de la Riviere, (The Netherlands), Alexander Doganov, (Bulgaria), Jaan Eha, (Estonia), Jean Fajadet, (France), Rafael Ferreira, (Portugal), Jerome Garot, (France), Julian Halcox, (UK), Yonathan Hasin, (Israel), Stefan Janssens, (Belgium), Kari Kervinen, (Finland), Gunther Laufer, (Austria), Victor Legrand, (Belgium), Samer A.M. Nashef, (UK), Franz-Josef Neumann, (Germany), Kari Niemela, (Finland), Petros Nihoyannopoulos, (UK), Marko Noc, (Slovenia), Jan J. Piek, (The Netherlands), Jan Pirk, (Czech Republic), Yoseph Rozenman, (Israel), Manel Sabate, (Spain), Radovan Starc, (Slovenia), Matthias Thielmann, (Germany), David J. Wheatley, (UK), Stephan Windecker, (Switzerland) and Marian Zembala, (Poland)The disclosure forms of the authors and reviewers are available on the ESC website (www.escardio.org/guidelines)Bare metal stentsCoronary artery bypass graftingCoronary artery diseaseDrug-eluting stentsEuroSCOREGuidelinesHeart teamMyocardial infarctionMyocardial ischaemiaMyocardial revascularizationOptimal medical therapyPercutaneous coronary interventionRecommendationRisk stratificationStable anginaSYNTAX scoreUnstable angina1. PreambleGuidelines and Expert Consensus Documents summarize and evaluate all available evidence with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk–benefit ratio of diagnostic or therapeutic means. Guidelines are no substitutes for textbooks and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s).The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).Members of this Task Force were selected by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) to represent all physicians involved with the medical and surgical care of patients with coronary artery disease (CAD). A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for society are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2.View this table:In this windowIn a new windowTable 1 Classes of recommendationsView this table:In this windowIn a new windowTable 2 Levels of evidenceThe members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at European Heart House, headquarters of the ESC. Any changes in conflict of interest that arose during the writing period were notified to the ESC. The Task Force report received its entire financial support from the ESC and EACTS, without any involvement of the pharmaceutical, device, or surgical industry.ESC …