esc 2014 guidelines myocardial revascularization

Strategies for Diagnosis: Functional testing & Imaging

Revascularization for stable CAD• Angina is associated with impaired quality of

life, reduced physical endurance, mental depression, and recurrent hospitalizations and outpatient visits

• Revascularization by PCI or CABG:more effectively relieves anginareduces the use of anti-angina drugs, andimproves exercise capacity and quality of life,

compared with a strategy of medical therapy alone

• Prior to revascularization, patients with SCAD must receive guideline-recommended medical treatment, due to its established benefits in terms of prognosis and symptom relief

• Revascularization and medical therapy should be seen as complementary, rather than competitive treatment strategies.

Indications for revascularization

PCI or CABG?

Revascularization in NSTEMI

• Timing of angiography and revascularization should be based on patient risk profile

Very high risk Pts: Urgent angiography < 2 hrs

High Risk: Early invasive strategy within 24 hrs

In lower-risk subsets, with aGRACE risk score of ,140 but with at least one secondary high-risk criterion:

invasive evaluation can be delayed without increased risk but should be performed during the same hospital stay, preferably within 72 hours of admission.

In other low-risk patients without recurrent symptoms: noninvasive assessment of inducible ischaemia should be performed before hospital discharge. 7.3 Type of revascularization

Revascularization in STEMI

Algorithm for treatment of cardiogenic shock

Revascularization in DM

Revascularization in CKD

Carotid artery screening before CABG