Comparison of ESC and ACC/AHA guidelines for myocardial revascularization

Abstract

In 2014, the Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery with the special contribution of the European Association of Percutaneous Cardiovascular Interventions published a comprehensive set of recommendations on myocardial revascularization in patients presenting with acute or chronic coronary artery disease. In the United States, pertinent guidance on this topic has been published by the American College of Cardiology, American Heart Association and other relevant societies in multiple guideline documents that have been published in recent years. This document brings together European and American recommendations on myocardial revascularization with a focus on the role of cardiac imaging.

Keywords: Guidelines; imaging; myocardial; revascularization.

Figure 1

Indications for coronary revascularization in patients with suspected obstructive CAD per ESC/EACTS and ACC/AHA guidelines. ^*CTA and stress echocardiography are ACC/AHA class II indication. ^†Defined as >50% coronary diameter stenosis with documented ischaemia on non-invasive imaging, or FFR ≤ 0.80 for diameter stenosis <90% (ESC guidelines); ≥50% left main, or ≥70% non-left main, or FFR ≤0.80 stenosis (ACC/AHA guidelines). ^‡This is a class IIb indication in patients with LVEF <35%. CABG, coronary artery bypass grafting; CAD, coronary artery disease; LAD, left anterior descending; LM, left main

Figure 2

ESC/EACTS and ACC/AHA guidance for the assessment of patients after coronary revascularization according to the presence of symptoms. ^*This includes the following: High-safety professions (e.g., pilots, drivers, divers), competitive athletes, patients engaging in strenuous recreational activities, sudden death survivors, patients with diabetes—especially if insulin-requiring, patients with incomplete or suboptimal revascularization, complicated course during revascularization, or multivessel CAD and residual intermediate lesions or with silent ischemia. ^†This recommendation is most appropriate in patients who can exercise adequately and have an interpretable ECG. CABG, coronary artery bypass grafting; CTA, computed tomographic angiography; PCI, percutaneous coronary intervention