Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 64, Issue 2, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezad286
Keywords
Coronary artery disease; clinical practice guidelines; coronary artery bypass grafting; Heart Team; left main coronary artery; left main stenosis; meta-analysis; myocardial revascularization; percutaneous coronary intervention; randomized controlled trials
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In October 2021, the ESC and EACTS established a Task Force to review recommendations on myocardial revascularization in patients with LM disease. The TF assessed new data, including aggregated data from four randomized trials comparing PCI with CABG. The TF concluded that both treatment options are clinically reasonable based on patient preference, expertise, and local operator volumes, but acknowledged gaps in knowledge and the limitations of the available data.
In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.
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