title: Impact of European Society of Cardiology and European Association for Cardiothoracic Surgery Guidelines on Myocardial Revascularization on the activity of percutaneous coronary intervention and coronary artery bypass graft surgery for stable coronary artery disease.
abstract: OBJECTIVE
  Joint guidelines on myocardial revascularization were published by the European Society of Cardiology and European Association for Cardiothoracic Surgery: Patients with left main stem, proximal left anterior descending, or 3-vessel disease should be discussed with a surgeon before revascularization, and ad hoc percutaneous coronary intervention has no elective indication in these categories. We assess the impact of the guidelines on referral patterns to a cardiac surgery service at a large-volume cardiac center in the United Kingdom.
  
  
  METHODS
  Joint guidelines were published in August 2010. All patients with severe disease undergoing percutaneous coronary intervention at one institution were identified 6 months before (January to June 2010) and 6 months after (January to June 2011) their introduction. Decision-making and surgical referral were determined from minutes of multidisciplinary meeting.
  
  
  RESULTS
  A total of 197 patients underwent elective percutaneous coronary intervention pre-guidelines, of whom 62 had severe disease. Only 6 patients (9%) were discussed at a multidisciplinary meeting before intervention. After introduction of the guidelines, elective percutaneous coronary interventions were performed in 164 patients, of whom 42 had surgical disease. Only 8 patients (17%) were discussed at a multidisciplinary meeting before intervention (P = not significant). Follow-up was a median of 480 (380-514) days for the pre-guideline group and 104 (31-183) days for the post-guideline group. Ad hoc percutaneous coronary intervention in surgical disease occurred in 8 patients (14%) pre-guidelines and was unchanged for 9 patients (26%) post-guidelines (P = not significant).
  
  
  CONCLUSIONS
  Despite recommendation by both cardiology and cardiac surgical bodies and widespread publicity, a significant number of patients in this single-center study are not receiving optimal treatment recommended by these guidelines.
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom.
authors: Martin T
authors: MT
authors: Yates
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom.
authors: Gopal K R
authors: GK
authors: Soppa
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom.
authors: Oswaldo
authors: O
authors: Valencia
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom.
authors: Sion
authors: S
authors: Jones
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom.
authors: Sami
authors: S
authors: Firoozi
authors: Departments of Cardiology and Cardiac Surgery, St George's Hospital, London, United Kingdom. Electronic address: marjan.jahangiri@stgeorges.nhs.uk.
authors: Marjan
authors: M
authors: Jahangiri
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006297:Health Services Accessibility / Q000592:standards; D061847:Hospitals, High-Volume; D006801:Humans; D033183:Interdisciplinary Communication; D008131:London; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
keywords: 23; CABG; EACTS; ESC; European Association for Cardiothoracic Surgery; European Society of Cardiology; LAD; LMS; PCI; RCA; coronary artery bypass grafting; left anterior descending; left main stem; percutaneous coronary intervention; right coronary artery