The 2018 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization provide comprehensive and updated evidence-based recommendations for the management of patients with myocardial ischemia. The guidelines cover various aspects, including diagnostic methods, decision-making, and patient information. Key points include: 1. **Diagnosis and Prognosis**: - Non-invasive methods (e.g., stress imaging, PET) can assess myocardial ischemia and viability in patients with heart failure and coronary artery disease. - Invasive methods, such as fractional flow reserve (FFR), are crucial for determining the functional significance of coronary stenoses, especially in cases of marginal stenoses and multi-vessel disease. 2. **Decision-Making**: - FFR is the gold standard for assessing the functional significance of coronary stenoses, with a threshold of ≤0.8 indicating hemodynamic significance. - In patients with marginal stenoses, FFR can guide the choice between percutaneous coronary intervention (PCI) and surgical revascularization. - FFR is particularly useful in patients with severe aortic stenosis and marginal stenoses of the left main coronary artery (LMA). 3. **Patient Information and Informed Consent**: - Patients should be fully informed about the benefits, risks, and alternatives of different treatment options. - Active participation of patients in decision-making is essential, and written informed consent is required for all procedures. 4. **Revascularization Strategies**: - PCI and coronary artery bypass grafting (CABG) are primary treatment options for patients with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS). - The choice between PCI and CABG depends on factors such as predicted surgical mortality, anatomical severity, and the extent of myocardial revascularization needed. - For patients with ACS without ST-segment elevation (STEMI), PCI is generally preferred over medical therapy, but the choice depends on the specific clinical scenario. 5. **Special Considerations**: - In patients with diabetes, chronic kidney disease, or valvular heart disease, additional considerations are necessary for revascularization strategies. - Technical aspects of PCI and CABG, including device selection and complications, are discussed in detail. 6. **Efficacy and Safety**: - The guidelines emphasize the importance of balancing the benefits and risks of different treatments. - Meta-analyses and randomized controlled trials (RCTs) are used to evaluate the effectiveness and safety of various revascularization strategies. 7. **Future Research Directions**: - Further RCTs are needed to compare different revascularization strategies, including the use of CT fractional flow reserve and coronary perfusion imaging. - Studies are also required to refine the role of FFR and other functional measures in guidingThe 2018 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization provide comprehensive and updated evidence-based recommendations for the management of patients with myocardial ischemia. The guidelines cover various aspects, including diagnostic methods, decision-making, and patient information. Key points include: 1. **Diagnosis and Prognosis**: - Non-invasive methods (e.g., stress imaging, PET) can assess myocardial ischemia and viability in patients with heart failure and coronary artery disease. - Invasive methods, such as fractional flow reserve (FFR), are crucial for determining the functional significance of coronary stenoses, especially in cases of marginal stenoses and multi-vessel disease. 2. **Decision-Making**: - FFR is the gold standard for assessing the functional significance of coronary stenoses, with a threshold of ≤0.8 indicating hemodynamic significance. - In patients with marginal stenoses, FFR can guide the choice between percutaneous coronary intervention (PCI) and surgical revascularization. - FFR is particularly useful in patients with severe aortic stenosis and marginal stenoses of the left main coronary artery (LMA). 3. **Patient Information and Informed Consent**: - Patients should be fully informed about the benefits, risks, and alternatives of different treatment options. - Active participation of patients in decision-making is essential, and written informed consent is required for all procedures. 4. **Revascularization Strategies**: - PCI and coronary artery bypass grafting (CABG) are primary treatment options for patients with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS). - The choice between PCI and CABG depends on factors such as predicted surgical mortality, anatomical severity, and the extent of myocardial revascularization needed. - For patients with ACS without ST-segment elevation (STEMI), PCI is generally preferred over medical therapy, but the choice depends on the specific clinical scenario. 5. **Special Considerations**: - In patients with diabetes, chronic kidney disease, or valvular heart disease, additional considerations are necessary for revascularization strategies. - Technical aspects of PCI and CABG, including device selection and complications, are discussed in detail. 6. **Efficacy and Safety**: - The guidelines emphasize the importance of balancing the benefits and risks of different treatments. - Meta-analyses and randomized controlled trials (RCTs) are used to evaluate the effectiveness and safety of various revascularization strategies. 7. **Future Research Directions**: - Further RCTs are needed to compare different revascularization strategies, including the use of CT fractional flow reserve and coronary perfusion imaging. - Studies are also required to refine the role of FFR and other functional measures in guiding