fin

ESC Guias Revascularizaci贸n mioc谩rdica

ESC Guias Revascularización miocárdica Contents: • Strategies of Diagnosis & severity of ischemia • Optimal medical therapy • Risk stratification. Clinical risk scores • Procedural risk scores • Heart Team: Multidisciplinary opinion • Patient informed decision • Specific recommendations • Special Conditions

ESC Guias Revascularizaci贸n mioc谩rdica

ESC Guias Revascularización miocárdica Optimal Medical Therapy • Antiischemic drugs • Antithrombotic treatment • Secondary prevention • Rehabilitation

ESC Guias Revascularizaci贸n mioc谩rdica Scores to calculate

Patient Risk

www.umassmed.edu/ outcomes/grace

ESC Guias Revascularizaci贸n mioc谩rdica Scores to calculate Risk of PCI & CABG

ESC Guias Revascularización miocárdica Patient information Æ Patient active role in decissions •Objective, •Unbiased, •Patient-oriented, •Evidence-based, •Up-to-date, reliable, •Understandable, •Accessible, •Relevant, •Consistent with legal requirements

ESC Guias Revascularizaci贸n mioc谩rdica Patient information (Apendix in guidelines)

ESC Guias Revascularizaci贸n mioc谩rdica Patient information (Apendix in guidelines)

ESC Guias Revascularizaci贸n mioc谩rdica Patient information (Apendix in guidelines)

ESC Guias Revascularizaci贸n mioc谩rdica Patient information (Apendix in guidelines)

ESC Guias Revascularizaci贸n mioc谩rdica Multidisciplinary Decision Pathways, Patient Info/consent & Timing of Intervention

The Heart Team

ESC Guias Revascularizaci贸n mioc谩rdica Multidisciplinary Decision Pathways, Patient Info/consent & Timing of Intervention

ESC Guias Revascularizaci贸n mioc谩rdica Revascularization In STE-ACS

ESC Guias Revascularizaci贸n mioc谩rdica Revascularization in Non STE-ACS

Risk Stratification in NSTE-ACS: Low < 108

3,500

High < 140 Troponin â&#x2C6;&#x2019; Troponin + Mortality

2,500 2,000

30 25 20

1,500

15

1,000

10

500 0

5 < 51

56

66

76

85

95

105 115 125 135 145 155 165 175 185 195 205 214 225 > 226

GRACE risk score intervals

N = 27,406 non-STE ACS patients

0

Inhospital mortality (%)

35

3,000

Patients (n)

40

ESC Guias Revascularizaci贸n mioc谩rdica PCI vs GABG Stable patients

ESC Guias Revascularizaci贸n mioc谩rdica Revascularization in Stable patients Indications for Revascularisation in Stable Angina or Silent Ischaemia * with documented ischaemia or FFR <0.80 for angiographic diameter stenoses 50-90%

ESC Guias Revascularización miocárdica Indications for CABG vs PCI in candidates for revasc. in stable angina or silent ischaemia with lesions suitable for both procedures & low surgical mortality Favours CABG

Favours PCI

IIa C

IC

1VD or 2VD – proximal LAD

IA

IIa B

3VD simple lesions, full functional revascularisation achievable with PCI, SYNTAX SCORE <22

IA

IIa B

3VD complex lesions, incomplete revascularisation achievable with PCI, SYNTAX SCORE > 22

IA

III A

Left Main (Isolated or 1VD, ostium/shaft)

IA

IIa B

Left Main (Isolated or 1VD, distal bifurcation)

IA

IIb B

Left Main + 2/3VD SYNTAX SCORE <33

IA

IIb B

Left Main + 2/3VD SYNTAX SCORE>33

IA

III B

Subset of CAD by anatomy 1VD or 2VD – non proximal LAD

ESC Guias Revascularizaci贸n mioc谩rdica

European Society of Cardiology: 53 countries