Myocardial revascularization appropriateness in Italy: measuring the unmeasured.

Myocardial revascularization, by either percutaneous coronary interventions (PCI) or coronary artery bypass grafting, represents the cornerstone of contemporary treatment of coronary artery disease. Myocardial revascularization aims to reduce myocardial ischemia and its adverse clinical manifestations in patients with coronary artery disease and flow-limiting coronary stenosis. In patients with stable ischemic heart disease (SIHD) already receiving guideline-recommended medical treatment, the indications for revascularization are based on symptoms and/or evidence of ischemia – as specified in the 2018 European Society of Cardiology (ESC) Guidelines on Myocardial Revascularization (Table 1). Evidence of ischemia is, therefore, pivotal to strategizing treatment, since revascularization more effectively relieves myocardial ischemia than medical treatment alone.