martes, 31 de agosto de 2010

European Society of Cardiology guidelines for Myocardial Revascularisation

The European Society of Cardiology (ESC) today announces the release of new Clinical Practice Guidelines covering Myocardial Revascularisation. These guidelines were developed following pioneering and extensive co-operation between the ESC and the European Association of Cardio-Thoracic Surgeons (EACTS). Myocardial Revascularisation – simply, the restoration of adequate blood and oxygen supplies to the heart – is the collective term for the response to the symptoms of coronary artery disease (CAD), including heart attacks and angina. The new guidelines will be presented at the ESC Congress in Stockholm on 29 August during the Clinical Practice Guidelines session in lecture room Stockholm, Zone K, starting at 0845hrs.
These guidelines reflect the fact that there are many options available to physicians to treat the many forms of CAD, both acute and non-acute. These include surgery, stent implantation and drug therapies, and the options cross traditional boundaries of medicine such as cardiology and surgery. “Our intention in writing these guidelines was to give patient-centred recommendations that lead to the most appropriate treatment regime for the different types of CAD,” said Doctor William Wijns of the ESC and Co-Chair of the Task Force. “We also wanted to provide reference materials based on best practice but not conditioned by the skill and preferences of individual physicians. The major challenge faced by physicians is not how to treat the CAD patient, but which of the many treatment options to select.”
The Task Force was made up of 24 experts, drawn equally from surgeons, interventional cardiologists and general cardiologists, and representing the ESC and the EACTS. The new guidelines are noteworthy for three main reasons:
They are an example of strong co-operation between the ESC and the EACTS, and have proved to very successful in meeting the objectives.
The content addresses the full extent of CAD, and of associated diseases, which was previously covered in separate guidelines, or not at all.
The guidelines introduce the concept of Heart Teams, essentially a grouping from across disciplines ensuring – when practical – that the patient is fully informed and takes part in the key decisions. The heart team should include one of each of the following specialists; interventional cardiologist, clinical cardiologist, and cardiac surgeon.
The guidelines encompass the full extent of CAD treatment and expected outcomes, including managing stable and unstable angina, myocardial infarction, diabetes-related symptoms and associated renal failure. Recommendations are made on all treatment options, from the technical aspects of stent implantation to the use of imaging technologies, and from risk management to follow-up activities.
The establishment of Heart Teams is a vital recommendation for medical teams everywhere, and formalises the make-up of the multi-discipline team responsible for patient care following CAD treatment. Co-Chair, Professor Philippe Kolh of the EACTS explains, “It is important that physicians offer patients the opportunity to influence the response to their condition. Clearly, for acute cases, such flexibility can be difficult to accommodate, but for the 30 percent of patients with stable conditions, it is an important factor. Immediate but less durable treatments such as a stent implantation may not be the right choice for some patients. Depending on their lifestyle and responsibilities, some may prefer to elect for a surgical procedure that offers a longer-term result.”

The complete guidelines document can be downloaded from the ESC website at

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