Management of Myocardial Revascularization Failure: An Expert Consensus Document of the EAPCI
Giulio G Stefanini1, ; Fernando Alfonso2; Emanuele Barbato3; Robert A Byrne4; Davide Capodanno5; Roisin Colleran6; Javier Escaned7; Daniele Giacoppo8; Vijay Kunadian9; Alexandra Lansky10; Julinda Mehilli11; Franz-Josef Neumann12; Damiano Regazzoli13; Jorge Sanz-Sanchez14; William Wijns15; Andreas Baumbach10;
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.