In 2014, the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) published a comprehensive set of recommendations on myocardial revascularization in patients presenting with acute or chronic coronary artery disease (CAD).1 In the United States, pertinent guidance on this topic has been published by the American College of Cardiology (ACC), American Heart Association (AHA), and other relevant societies in multiple guideline documents that have been published in recent years.2,3,4,5,6,7,8,9,10 This document brings together European and American recommendations on myocardial revascularization for side-by-side comparison; class (I, II or III) and level of evidence (A, B or C) are shown for each recommendation (Tables 1, 2, 3, 4, 5, 6 and Figures 1, 2). This is followed by two Editorial comments that reflect on the similarities and the differences between European and American guidance and the relevance of these to clinical practice. This represents the second of a new series of comparative guidelines review; the first of these focused on the recently published ACC/AHA and ESC/ESA guidelines for the cardiovascular evaluation and management of patients undergoing non-cardiac surgery.11,12,13

Table 1 Indications for diagnostic imaging in patients with suspected CAD
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Table 2 Indications for revascularization in patients with stable angina or silent ischemia according to the extent of CAD
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Table 3 Recommendations for non-invasive evaluation before revascularization in patients presenting with an acute coronary syndrome
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Table 4 Recommendations on revascularization in patients with chronic heart failure and systolic LV dysfunction according to the presence of viable and /or scarred myocardium
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Table 5 Recommendations for stress testing and ischemia-guided revascularization in special groups
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Table 6 Strategies for follow-up and management after myocardial revascularization
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Figure 1
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Indications for coronary revascularization in patients with suspected obstructive CAD per ESC/EACTS and ACC/AHA guidelines. *CTA and stress echocardiography are ACC/AHA class II indication. †Defined as >50% coronary diameter stenosis with documented ischaemia on non-invasive imaging, or FFR ≤ 0.80 for diameter stenosis <90% (ESC guidelines); ≥50% left main, or ≥70% non-left main, or FFR ≤0.80 stenosis (ACC/AHA guidelines). ‡This is a class IIb indication in patients with LVEF <35%. CABG, coronary artery bypass grafting; CAD, coronary artery disease; LAD, left anterior descending; LM, left main

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Figure 2
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ESC/EACTS and ACC/AHA guidance for the assessment of patients after coronary revascularization according to the presence of symptoms. *This includes the following: High-safety professions (e.g., pilots, drivers, divers), competitive athletes, patients engaging in strenuous recreational activities, sudden death survivors, patients with diabetes—especially if insulin-requiring, patients with incomplete or suboptimal revascularization, complicated course during revascularization, or multivessel CAD and residual intermediate lesions or with silent ischemia. †This recommendation is most appropriate in patients who can exercise adequately and have an interpretable ECG. CABG, coronary artery bypass grafting; CTA, computed tomographic angiography; PCI, percutaneous coronary intervention

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