title: Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology/Canadian Society of Cardiac Surgery position statement on revascularization--multivessel coronary artery disease.
abstract: This position statement addresses issues in revascularization for multivessel coronary artery disease (CAD) from the perspective of both cardiologists and cardiac surgeons. Recommendations are made based on evidence from clinical trials and observational studies, with an emphasis on the increasing number of individuals with significant comorbid disease burden and functional debilitation who are being referred for definitive management of their multivessel CAD in the context of routine clinical practice. These types of individuals have traditionally not been included in the many clinical trials that have been the basis for guidelines and recommendations, and the objective of the proposed medical intervention or revascularization (or both) would not necessarily be to improve prognosis but to improve quality of life. One purpose of this document is to propose practical multidisciplinary approaches to the management of these patients. Recommendations are made for revascularization in acute coronary syndromes and stable CAD, with specific considerations for individuals with left ventricular dysfunction and heart failure, chronic renal failure, and chronic obstructive pulmonary disease. We also consider the use of various risk scores, including the Society of Thoracic Surgeons score, the EuroSCORE, and the SYNTAX II score. The importance of a heart team approach is also emphasized. The complementary role of coronary bypass surgery and percutaneous coronary intervention is highlighted, along with the importance of optimal medical therapy.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: teok@mcmaster.ca.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Schulich Heart Centre, Sunnybrook Medical Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Buller
authors.affiliation: Saint John Regional Hospital, Saint John, New Brunswick, Canada.
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.affiliation: St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Carere
authors.affiliation: Departments of Medicine, Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jafna L
authors.initials: JL
authors.lastname: Cox
authors.affiliation: Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Hung
authors.initials: H
authors.lastname: Ly
authors.affiliation: Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Fedak
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Kwan
authors.initials: K
authors.lastname: Chan
authors.affiliation: Department of Surgery, Dalhousie University, Dalhousie, Nova Scotia, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Légaré
authors.affiliation: Department of Medicine, St. Michael's Hospital & Sunnybrook Medical Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Connelly
authors.affiliation: Montreal Heart Institute, Univérsite de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Tanguay
authors.affiliation: St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.affiliation: Department of Medicine, McMaster University, Brampton, Ontario, Canada.
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: G B
authors.initials: GB
authors.lastname: John Mancini
authors.affiliation: Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.affiliation: CK Hui Heart Centre, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Randall
authors.initials: R
authors.lastname: Williams
authors.affiliation: Southlake Regional Hospital, McMaster University, Newmarket, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Teoh
authors.affiliation: Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Latter
authors.affiliation: Interior Health, Kelowna, British Columbia, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Townley
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meyer
mesh_terms: D002170:Canada; D002309:Cardiology; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D009204:Myocardial Revascularization / Q000592:standards*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical