[The heart team in planning and performance of revascularization : ESC guidelines versus clinical routine].

The heart team, consisting of conservative cardiologists, cardiac surgeons and interventional cardiologists, is important for a balanced, multidisciplinary decision-making process for patients suffering from coronary artery disease (CAD). Standard evidence-based, interdisciplinary, institutional protocols can be used for commonly encountered case scenarios to avoid the need for a systematic case by case review. Complex cases with a SYNTAX score of more than 32, diabetes mellitus and lesions of the left main stem or three-vessel disease should in general not be treated by an ad hoc percutaneous coronary intervention (PCI) but first discussed in the heart team. Culprit lesion PCI is usually the first choice in most patients with acute coronary syndrome. If complete percutaneous revascularization is not possible, coronary artery bypass grafting (CABG) should be considered by the heart team. In patients assigned for CABG, timing of the procedure should be decided on an individual basis, depending on the symptoms, hemodynamic stability, coronary anatomy and signs of ischemia. In stabilized patients with acute coronary syndrome, the choice of revascularization modality can be made in analogy to patients with stable CAD.