red br Experimental Procedures br Author
Author Contributions H.G. and X.-Y.F. conceived and designed the project. H.G., D.V.D., and X.L. performed most of the experiments and analyzed the data. L.X. helped on Mettl8 KO ESC, RIP, and translational study. Y.S. performed FACS analysis. Y.W. helped with cardiomyocytes differentiation. N.S. helped to create the Mettl8 KO mice under J.Y.’s and X.L.’s guidance. Y.L. and H.Y. analyzed the RNA-seq data. G.A.T. provided technical assistance. J.M.N. and H.G. performed the sucrose gradient sedimentation. H.G., X.L., and X.F. wrote the manuscript. All authors discussed the results and commented on the manuscript.
Acknowledgments This work is supported by grants from the Singapore National Medical Research Council (R-713-000-181-511) and the Ministry of Education (R-713-000-169-112) and by the National Research Foundation Singapore and the Singapore Ministry of Education under its Research Centres of Excellence initiative. The authors declare no competing financial interests.
INTRODUCTION AND COMMENTARY ON THE METHODOLOGY The Spanish Society of Cardiology endorses the clinical practice guidelines (CPG) published by the European Society of Cardiology (ESC). As part of this red policy, ESC guidelines are translated into Spanish and published in the online version of Revista Española de Cardiología, with the aim of increasing their accessibility and facilitating their implementation. The translated articles are accompanied by an editorial authored by a panel of Spanish experts that highlights the most important content of each CPG document, details changes and innovations introduced since the previous edition, and discusses the more contentious aspects and possible limitations. The editorial also seeks to evaluate and adapt the recommendations to the context of health care organization and clinical practice in Spain. The latest ESC guidelines for myocardial revascularization1 update the previous CPG published in 2014. It should be noted that a major effort has been made to maintain coherence with previous guidelines.
DIAGNOSTIC TOOLS TO GUIDE MYOCARDIAL REVASCULARIZATION
PROCESS FOR DECISION-MAKING AND PATIENT INFORMATION For a number of reasons, fewer coronary artery bypass grafting (CABG) procedures are performed in Spain than in comparable countries, which is reflected in a lower rate of CABG relative to percutaneous coronary intervention (PCI), according to data from the Organisation for Economic Co-operation and Development.
REVASCULARIZATION FOR STABLE CORONARY ARTERY DISEASE Compared with the previous guidelines,2 the new guidelines give less weight to the EuroSCORE II in the prediction of surgical mortality (IIa B in 2014 vs IIb B in 2018), whereas the STS and SYNTAX scores maintain a class I B recommendation. The logistic EuroSCORE and other scores are no longer considered, and the use of the SYNTAX-II score is not recommended. The ESC Task Force members acknowledge the major limitations of the SYNTAX score, but nonetheless still regard labia minora as a basic tool in the choice of revascularization method, a conclusion supported by data from a recent collaborative individual patient pooled analysis of randomized trials. To date, only 1 study has compared CABG and PCI specifically in relation to the SYNTAX score. The new guidelines reduce the left ventricular ejection fraction (LVEF) cutoff for indicating revascularization in patients with multivessel disease and documented ischemia; the cutoff was previously ≤ 40% and is now ≤ 35% (I A). The new guidelines add the possibility of revascularization of lesions with FFR < 0.75 (I B). 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 unsuitable for guiding changes to clinical practice. Nevertheless, the ORBITA study underlines the importance of optimal medical treatment for patients with stable CAD.