Comments on the 2014 ESC/EACTS guidelines on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

The 2014 guidelines are mainly concerned with the decision-making process regarding the revascularization policy for patients with coronary artery disease. The need for emergency or urgent revascularization in patients with ST segment elevation myocardial infarction or non-ST segment elevation acute coronary syndromes is again highlighted in the current guidelines. The decision-making process is, however, more demanding for patients with stable coronary artery disease due to the variety of treatment options that are available. Indeed, patient-related factors may profoundly impact the decision-making process as long as existing evidence provides no clear survival advantages for one of the treatment options. An essential component of the multidisciplinary approach is the heart team, which is mainly made up of non-invasive cardiologists, cardiac surgeons and interventional cardiologists. Although the decision-making process should provide the best revascularization option for each patient, it should also support an efficient clinical workflow. For this reason, the interdisciplinary heart team is encouraged to formulate institutional protocols to guide revascularization strategies for common case scenarios. The institutional protocols are not only based on existing evidence as reflected in the current guidelines on myocardial revascularization but also on the specific experience and strengths of local departments of interventional cardiology and cardiac surgery. © 2016, Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e.V. Published by Springer Medizin Verlag Berlin - all rights reserved.