INVASIVE MANAGEMENT: BASIS FOR DECISION-MAKING

The spectrum of clinical conditions associated with the presence of myocardial ischemia and related symptoms (angina pectoris or equivalent), regardless of the cau-sative mechanism (obstructive disease, microvascular dysfunction or coronary spasm) is called chronic coronary syndrome (CCS). Although the essence of the treatment of patients with SCC consists of changes in lifestyle and strict control of cardiovascular risk factors, in addition to antianginal therapy in maximally tolerated doses, surgical or percutaneous revascularization procedures are indicated when medical treatment fails to offer adequate symptoms control or in scenarios in which they provide a reduction in the risk of events compared to clinical therapy alone. Thus, patients with left main disease, multivessel disease (especially diabetics or those with high angiographic complexity), patients with HFrEF of ischemic etiology, and those with the last remaining patent vessel or proximal lesion of the anterior descending artery should be candidates for intervention. The choice of the intervention modality should be based on robust scientific evidence as proposed by current guidelines. In general terms, clinical parameters (patient frailty, comorbidities, and analysis of left ventricular function, for example), angiographic para-meters (anatomical complexity), and technical parameters (experience of the local team and availability of specific devices such as IVUS) are analyzed by the Heart Team in the decision-making process.