Transatlantic Editorial: a comparison between European and North American guidelines on myocardial revascularization

Trends in Coronary Revascularization and Ischemic Heart Disease–Related Mortality in Israel

“…Despite the unequivocal evidence reflected in professional cardiovascular societies guidelines for revascularization, subjective physician, institutional, and patient factors continue to play a major role in the bias towards a specific type of revascularization procedure. Physician‐related factors include unfamiliarity with the most recent data and updated guidelines, operator bias, and conflicts of interest inherent to the setting where the same operator performs the diagnostic and therapeutic procedures.…”

“…Five-year data from prospective randomized trials including the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery), BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes), and FREEDOM (Future Revascularization Evaluation in Patients With Diabetes Mellitus: Optimal Management of Multivessel Disease) trials, large "real-world" registries and meta-analyses showed that in these patient populations, CABG is superior to PCI with regards to midterm survival, incidence of major adverse cardiac events, and rates of repeat revascularization. [15][16][17][18][19][20] Despite the unequivocal evidence reflected in professional cardiovascular societies guidelines for revascularization, 5 subjective physician, institutional, and patient factors continue to play a major role in the bias towards a specific type of revascularization procedure. Physician-related factors include unfamiliarity with the most recent data and updated guidelines, operator bias, and conflicts of interest inherent to the setting where the same operator performs the diagnostic and therapeutic procedures.…”

“…3,4 The guidelines for treatment of IHD developed by the various cardiovascular professional societies provide clinicians with a useful tool in selecting the optimal treatment for the individual patient. 5 More recently, appropriate use criteria were defined and updated in an effort to reduce the impact of physician bias, to promote the "heart team" concept, and to decrease the impact of institutional financial pressure on clinical decisions. 6 The impact of practice guidelines and appropriateness criteria on actual decision making is a subject of ongoing investigations.…”

Commentary: Total arterial revascularization: Is it for everyone?

“…The use of MAG is now recommended in the Society of Thoracic Surgeons practice guidelines for CABG 2 and TAR is now a class IIB recommendation for patients younger than age 60 years with few comorbidities in the American guidelines and a class IIA recommendation for patients with a reasonable life expectancy in the European guidelines. 3 It has been strongly suggested that bilateral ITA grafting be made a quality metric for CABG reimbursement. Despite these recommendations, the most recent Society of Thoracic Surgeons National Database indicates that a single ITA graft is used in 89.4% of CABG patients, MAG in 10.6%, and bilateral ITA in only 4.9%.…”

Arterial grafting for coronary revascularisation and the illusive search for truth

“…Both ACC/AHA and European guidelines provide less than enthusiastic Class IIa recommendation for BITA grafting (reasonable; additional studies needed) LOE B (non-randomised studies) 6. BITA grafting is used in a meagre 5.4% of coronary artery bypass grafting (CABG) cases reported in the Society of Thoracic Surgeons adult cardiac surgery database, which currently represents 90% of centres performing adult cardiac surgery in the USA.…”