2018 ESC/EACTS Guidelines on myocardial revascularization.

Introducción: la cirugía de revascularización miocárdica avanza cada día más en cuanto a su efectividad terapéutica, pero todavía se hace necesario el control de determinados factores que pueden llevar a un pronóstico negativo. Objetivo: determinar los factores asociados a la incidencia de lesión miocárdica isquémica perioperatoria en los pacientes sometidos a cirugía de revascularización miocárdica. Material y Métodos: estudio analítico de casos y controles en pacientes con enfermedad multivasos sometidos a cirugía de revascularización miocárdica. El universo de 107 pacientes quedó dividido en: el grupo expuesto la lesión miocárdica isquémica perioperatoria (n=14) y el grupo no expuesto a esta (n=93). Se estudiaron variables epidemiológicas, clínicas, de laboratorio, electrocardiográficas y ecocardiográficas. Se usó el test chi cuadrado, el test exacto de Fisher y t de Student para comparación de medias, entre otros. Resultados: El área bajo la curva ROC determinó que el índice de masa corporal, el euroscore estándar, el tiempo quirúrgico, los valores de Creatinina y el índice leucoglicémico se asociaron predictivamente con la ocurrencia de lesión miocárdica isquémica perioperatoria. El análisis multivariado determinó como factores asociados al índice de masa corporal ≥ 24,9 kg/m2 (p=0,000), la clasificación de la New York Heart Association ≥ III (p=0,001), el euroscore estándar ≥ 4 puntos (p=0,037), el tiempo quirúrgico ≥ 4,7 h (p=0,015) y niveles de creatinina ≥ 101,5 μmol/L (p=0,050). Conclusiones: la identificación temprana de variables como el índice de masa corporal, la clasificación de la NYHA, el euroscore estándar, el tiempo quirúrgico y los niveles de Creatinina podría indicar qué pacientes necesitan un seguimiento más estrecho durante el preoperatorio

2018 ESC/EACTS Guidelines on myocardial revascularization

The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI)

Guidelines on myocardial revascularization

Guidelines and Expert Consensus Documents summarize and evaluate all available evidence with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk benefit ratio of diagnostic or therapeutic means. Guidelines are no substitutes for textbooks and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s). The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/ guidelines/rules). Members of this Task Force were selected by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) to represent all physicians involved with the medical and surgical care of patients with coronary artery disease (CAD). A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk benefit ratio. Estimates of expected health outcomes for society are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2. The members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at European Heart House, headquarters of the ESC. Any changes in conflict of interest that arose during the writing period were notified to the ESC. The Task Force report received its entire financial support from the ESC and EACTS, without any involvement of the pharmaceutical, device, or surgical industry. ESC and EACTS Committees for Practice Guidelines are responsible for the endorsement process of these joint Guidelines. The finalized document has been approved by all the experts involved in the Task Force, and was submitted to outside specialists selected by both societies for review. The document is revised, and finally approved by ESC and EACTS and subsequently published simultaneously in the European Heart Journal and the European Journal of Cardio-Thoracic Surgery. After publication, dissemination of the Guidelines is of paramount importance. Pocket-sized versions and personal digital assistant-downloadable versions are useful at the point of care. Some surveys have shown that the intended users are sometimes unaware of the existence of guidelines, or simply do not translate them into practice. Thus, implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations

Myocardial revascularization

Cardiolog

Guidelines on the management of valvular heart disease (version 2012)

Cardiolog