The 2010 ESC/EACTS guidelines on myocardial revascularisation

At the European Society for Cardiology annual meeting in Stockholm at the end of August 2010, the new joint European Society of Cardiology (ESC) and European Association for Cardiothoracic Surgery (EACTS) guidelines on myocardial revascularisation were published online.1 These are a completely new set of guidelines which incorporate the 2006 percutaneous coronary intervention (PCI) guidelines on the management of stable angina pectoris2 and also contain important differences reflecting advances in the clinical management of ischaemic heart disease and advocating a more formal multidisciplinary approach to intervention in such patients. In contrast to previous guidelines for interventions in coronary artery disease produced independently by the cardiology and cardiac surgery communities, the new ESC/EACTS collaborative effort recognises the need for cohesive guidelines applicable to the management of the entire spectrum of coronary artery disease. While less severe disease can be adequately treated by lifestyle changes and optimal medical therapy, more severe disease may additionally require intervention by stenting or surgery. Accordingly, the writing committee, which was co-chaired by a cardiologist and a surgeon, consisted of 25 members in total and included nine non-interventional cardiologists, eight interventional cardiologists and eight cardiac surgeons. This is in marked contrast to the previous ESC guidelines task force which included a single cardiac surgeon among its 16 members.2 It should also be noted that the guidelines were produced without any commercial sponsorship from the pharmaceutical or interventional or surgical device industry, who are all powerful players in the cardiovascular arena. After several revisions, the guidelines were approved by the external reviewers from the respective societies. The ESC guidelines are based on a ‘comprehensive review of the published evidence’3 with a ‘formal meta-analysis at the beginning of the writing phase’.4 However, it has also to be acknowledged that, as with all guidelines, some …