This section of the CPG document addresses the

This section of the CPG document addresses the controversial issue of the possible placebo effect of PCI, indicated by the ORBITA study. The Task Force members conclude that, despite its elegant design, the ORBITA study has major limitations that make it Solasodine unsuitable for guiding changes to clinical practice. Nevertheless, the ORBITA study underlines the importance of optimal medical treatment for patients with stable CAD. The new ESC guidelines incorporate data from a network meta-analysis of 100 studies confirming that new-generation drug-eluting stents (DES) improve survival compared with medical treatment, although this has not been demonstrated in any individual study.
REVASCULARIZATION IN NON–ST-ELEVATION ACUTE CORONARY SYNDROME The invasive strategy remains the standard treatment for most patients with non–ST-segment elevation acute coronary syndrome (NSTEACS). The early invasive strategy (intervention in the first 24hours) is recommended for most NSTEACS patients, including those with elevated troponins, repolarization changes, or a GRACE score> 140. The debate about the basis for intervention within 24hours is an old one, and this strategy has well-known logistic and procedural implications that may significantly contribute to its incomplete implementation in Spain. Therefore, in Spain, the decision on whether to use the early invasive strategy should be informed by consideration of regional health care organization and the type of hospital to which the patient is admitted.
REVASCULARIZATION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH HEART FAILURE
Revascularization in special patient groups
REPEAT REVASCULARIZATION Patients treated by PCI can develop angina during follow-up due to restenosis, incomplete revascularization, or disease progression, with disease progression being the most frequent cause in the long-term. In patients with restenosis, repeat PCI remains the strategy of choice. Both DES and drug-coated balloon angioplasty are recommended for patients with restenosis of a bare-metal stent or a DES (class I A). Intracoronary imaging provides useful information about the mechanism of stent failure caused by restenosis or thrombosis and aids decision-making about optimal treatment (IIa C).
ARRHYTHMIAS Coronary revascularization should always be considered for CAD patients with LVEF <35% before they are fitted with an implantable cardioverter-defibrillator for primary prevention. CABG reduces 10-year mortality in patients with reduced LVEF. Irrespective of the ECG pattern, survivors of out-of-hospital cardiac arrest with no obvious noncardiac cause of the arrhythmia should undergo early coronary angiography (IIa C). Patients who develop atrial fibrillation (AF) as a complication of PCI or CABG should be assessed for anticoagulation. Beta-blocker therapy should be considered as a measure to prevent the appearance of AF after CABG (I B).