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

Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

Specific Pharmacological Profile of A 2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

“…Here, nearly one‐third of the patients with suspected CAD and non‐contributive electrocardiography and troponin had FFR <0.8. Albeit the existence of an FFR “gray zone” from 0.75 to 0.80 was previously reported for decision‐making,35, 36, 37 where the chosen FFR threshold value of 0.80 was clearly associated with the presence of spare A 2A R displaying a high K D /EC 50 ratio. Importantly, this test may help distinguish patients who require hospitalization in a cardiac department or monitoring only.…”

“…Only ACS statut constitutes an issue for FFR measurement (duration and intensity of ischemia, embolization spasm) while the clinical impact of these changes is minimal. Earlier data comparing FFR measurements at the acute phase or a week later would have led the same clinical decision about the need for revascularization 35. At least, our study included patients on average 4 days after the index period (delay for performing non‐invasive tests), which suggested a majority of stabilized “unstable syndromes” while we have excluded high‐risk patients.…”

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

“…However, cumulative evidence suggests that angiographically determined anatomical stenosis severity often underestimates or overestimates the functional significance of lesions 5, 6, 7. Fractional flow reserve (FFR) is currently the standard for decision‐making regarding revascularization in the catheter laboratory and has become part of the clinical guidelines for the assessment of the physiological significance of epicardial coronary stenosis based on sound concepts and randomized clinical trials 8, 9, 10, 11. However, FFR evaluation is still underutilized; instead, coronary angiography is widely used as a gatekeeper for decision‐making of revascularization even in large clinical trials 2, 12.…”

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

“…Fractional flow reserve (FFR) is the standard in decision making for revascularization in the catheter laboratory and has become a part of the clinical guidelines for assessing the physiological significance of epicardial coronary stenosis based on a sound concept and randomized clinical trials 1, 2, 3, 4. A recent study also suggested that FFR measured after percutaneous coronary intervention (PCI) has prognostic value, with an inverse relationship to subsequent clinical events 5.…”