May 1, 2026European Heart Journal
‘Ten commandments’ for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization
Why the study?
The 2018 ESC/EACTS Guidelines on Myocardial Revascularization were developed to update and support clinical practice with evidence-based and expert recommendations addressing myocardial revascularization strategies.
Population
Patients with coronary artery disease considered for myocardial revascularization
Comparison
Percutaneous coronary intervention versus coronary artery bypass grafting
Design
Joint ESC/EACTS guideline based on clinical trials, meta-analyses, and expert consensus
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
RBRobert ByrneInterventional cardiologist, Mater Private Network, Dublin
“First and foremost, both PCI and CABG are clinically reasonable for the treatment of these patients. We've maintained a class I recommendation for CABG. I think that was an easy decision. As for the IIa recommendation for PCI, there were a couple of reasons. Number one, the SYNTAX score or SYNTAX tertiles didn't seem to be a strong effect modifier in the lower two tertiles. It was really an arbitrary distinction between low and intermediate risk so we felt that the same recommendation should really apply to both.”
CBColin BaigentChair, ESC Clinical Practice Guidelines Committee, Oxford
“That will be able to give us a much clearer insight into the effects of treatment, not just according to the definitions of MI where the main discussion is at the moment but particularly the long-term outcomes.”
CBColin BaigentChair, ESC Clinical Practice Guidelines Committee, Oxford
“It is intended that the review pays particular attention to longer-term follow-up of the relevant trials, and to a meta-analysis of individual participant data from those trials. It should be noted, however, that the panel will be asked to consider the totality of evidence and not just the findings of EXCEL, as it is important that the findings of EXCEL are weighed together with the evidence from other trials.”
Implication
The 'Ten Commandments' of the 2018 ESC/EACTS guidelines summarize the core principles for selecting and performing myocardial revascularization strategies.
Key Points
- Summarize core recommendations from the 2018 European clinical practice guidelines to guide clinical decision-making between percutaneous coronary intervention and coronary artery bypass grafting.
- A joint Task Force of interventional cardiologists, cardiac surgeons, and non-interventional cardiologists reviewed clinical trials and meta-analyses to update the 2010 and 2014 guidelines.
- The Task Force applied a conservative approach, maintaining previous recommendations unless modification was explicitly mandated by robust new evidence.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) both alleviate myocardial ischemia, but CABG yields superior long-term survival and lower repeat intervention rates in extensive coronary disease and diabetes mellitus.
- Guideline directives emphasize complete revascularization, objective documentation of ischemia, anatomical complexity evaluation via the SYNTAX score, and Heart Team deliberation for complex presentations.
- Procedural standards mandate the default use of radial access and drug-eluting stents for PCI, alongside multiple arterial grafting with the radial artery or bilateral internal mammary arteries for CABG.
Structured PICO
P
Population
Patients with coronary artery disease considered for myocardial revascularization
I
Intervention
Myocardial revascularization (percutaneous coronary intervention or coronary artery bypass grafting)
The 'Ten Commandments' of the 2018 ESC/EACTS guidelines summarize the core principles for selecting and performing myocardial revascularization strategies.
Cite This Study
Neumann et al. (2019) conducted a review in Coronary Artery Disease. Myocardial Revascularization (PCI and CABG) was evaluated. The 2018 ESC/EACTS Guidelines outline ten key principles for myocardial revascularization, highlighting the roles of PCI and CABG based on coronary disease complexity and diabetes.