A joint review of evidence into the treatment of patients at low surgical-risk with left main coronary disease has concluded that both coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) are clinically reasonable based on patient preference, available expertise and operator volume.
This was the outcome of a collaborative review undertaken by the European Society of Cardiology (ESC) and the European Association for Cardiothoracic Surgery (EACTS), which included the joint guidelines issued by the two organisations on myocardial revascularisation in 2018. EACTS withdrew its support for the 2018 guidelines, after a BBC investigation cast doubt on the findings of the EXCEL clinical trial, which was among the evidence used to inform the drafting of the guidelines.
The review was authored by a panel chaired by Robert Byrne (RSCI University of Health Sciences, Dublin, Ireland) and Stephen Fremes (Sunnybrook Research Institute, Toronto, Canada), and its outcomes have been published in both the European Heart Journal and the European Journal of Cardio-Thoracic Surgery.
The writing panel have advised that in future guidelines the class of recommendation and level of evidence for CABG should be class I and level of evidence A, whilst for PCI it should be class IIa and level of evidence A.
Their report and associated materials are now being considered by the Task Force which is working on a new guideline for chronic coronary syndromes, scheduled for publication in August 2024.
Until then, the ESC and EACTS have stated that that local heart teams should consider both the 2018 guidelines and the findings of the expert group when discussing the management of patients with stable coronary artery disease.