The following are key points to remember from the 2018 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) on myocardial revascularization:

1. The prognostic and symptomatic benefits of myocardial revascularization critically depend on the completeness of revascularization. Therefore, the ability to achieve complete revascularization is a key issue when choosing the appropriate treatment strategy.
2. Apart from issues of individual operative risk and technical feasibility, diabetes mellitus and the anatomical complexity of coronary artery disease (CAD) determine the relative benefits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
3. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score is the recommended tool to gauge the anatomical complexity of coronary disease.
4. In some instances, both PCI and CABG are equally reasonable or sometimes even equally problematic options. This calls for the Heart Team to be consulted to develop individualized treatment concepts, with respect for the preferences of the patient who has been informed about early and late outcomes.
5. Radial access is preferred for any PCI regardless of clinical presentation, unless there are overriding procedural considerations.
6. Drug-eluting stents (DES) are recommended for any PCI regardless of clinical presentation, lesion type, anticipated duration of dual antiplatelet therapy (DAPT), or concomitant anticoagulant therapy.
7. Even though 6 months of DAPT is generally recommended after PCI in stable CAD and 12 months of DAPT after acute coronary syndrome, the type and duration of DAPT should be individualized according to the ischemic and bleeding risks, and appropriately adapted during follow-up. Based on this judgment, treatment durations for DAPT after DES that are as short as 1 month or even as long as lifelong may be reasonable.
8. In cardiogenic shock, routine revascularization of noninfarct-related artery lesions is not recommended during primary PCI.
9. Off-pump surgery with no-touch aorta for high-risk patients should be considered when expertise exists.
10. Multiple arterial grafting should be considered using the radial artery for high-grade stenosis and/or bilateral internal mammary artery grafting for patients who do not have an increased risk of sternal wound infection.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and ACS, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and ACS

Keywords: Acute Coronary Syndrome, Anticoagulants, Cardiac Surgical Procedures, Constriction, Pathologic, Coronary Artery Bypass, Diabetes Mellitus, Drug-Eluting Stents, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Shock, Cardiogenic

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