The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Management of Myocardial Revascularization Failure: An Expert Consensus Document of the EAPCI

DOI: 10.4244/EIJ-D-20-00487

1. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy, Italy
2. Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Spain
3. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
4. Dublin Cardiovascular Research Institute, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
5. Division of Cardiology, Azienda-Ospedaliero-Universitaria “Policlinico G: Rodolico- San Marco”, University of Catania, Italy
6. Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Dublin Cardiovascular Research Institute, Mater Private Hospital, Dublin, Ireland
7. Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
8. Alto Vicentino Hospital, Vicenza, Italy; Deutsches Herzzentrum München, Munich, Germany
9. Transational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
10. Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre London, United Kingdom
11. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
12. Department of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Germany
13. Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milan, Italy
14. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
15. The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, National University of Ireland Galway, Ireland
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Myocardial revascularization represents the most frequently performed therapeutic

intervention worldwide. Current percutaneous and surgical revascularization

techniques provide excellent short- and long-term clinical outcomes. However, despite

the technological and procedural advances with the widespread use of drug-eluting

stents and arterial bypass grafts in contemporary practice, a considerable proportion of

patients require repeat revascularization procedures during long-term follow-up. The

need for repeat revascularization has a major impact on patients quality of life and is

associated with a significant economic burden. This Consensus Document summarizes

the views on the management of myocardial revascularization failure of an expert panel

of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). The

present document provides a broad and pragmatic overview of the clinical management

of myocardial revascularization failure with a focus on the three key underlying

mechanisms leading to repeat revascularization: 1) failure of percutaneous coronary

interventions, 2) failure of coronary artery bypass grafting and 3) progression of

coronary artery disease in native coronary segments previously untreated. The scope of

the present position document is to provide a patient-oriented approach for the

management of myocardial revascularization failure.

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