Secondary coronary revascularisation: an emerging issue.
Coronary revascularisation should be considered as a healthcare process rather than a series of episodic interventions. At a time when the number of surgical and interventional procedures worldwide continues to increase, secondary coronary revascularisation appears as an unavoidable subject. Atherosclerosis progression, long-term failure of surgical grafts or stents, and patient profile contribute to the increased risk of secondary revascularisation. The absence of a grouping category, however, has contributed to suboptimal implementation of evidence-based knowledge on the subject, which is scattered in the literature and scantily covered in clinical practice guidelines. Assembling a critical mass of expertise in the field results mandatory for comprehensive patient management and for highlighting avenues for future research. Knowledge sharing between physicians, interventionalists and surgeons appears indispensable to reduce unilateral decision-making. Awareness of all health professionals about the likelihood of repeated revascularisation appears as the first step towards a process-oriented and holistic management of patients requiring coronary revascularisation.
Escaned
Javier
J
Instituto Cardiovascular, Hospital Clinico San Carlos, 28040 Madrid, Spain. escaned@secardiologia.es
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D019317:Evidence-Based Medicine; D049674:History, 21st Century; D006801:Humans; D017410:Practice Guidelines as Topic; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D017211:Treatment Failure