The impact of Heart Team discussion on decision making for coronary revascularization in patients with complex coronary artery disease

The impact of Heart Team discussion on decision making for coronary revascularization in patients with complex coronary artery disease

Background and Aim Revascularization guidelines support routine Heart Team (HT) discussion of appropriate patients. The effect of HT on decision making and clinical outcomes has not been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization....

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Veröffentlicht in:Journal of cardiac surgery 2020-10, Vol.35 (10), p.2719-2724
Hauptverfasser: Kezerle, Louise, Yohanan, Eli, Cohen, Avshalom, Merkin, Miri, Ishay, Yaron, Weinstein, Jean M., Cafri, Carlos
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complex coronary artery disease
Heart Team discussion
revascularization method
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container_end_page 2724
container_issue 10
container_start_page 2719
container_title Journal of cardiac surgery
container_volume 35
creator Kezerle, Louise
Yohanan, Eli
Cohen, Avshalom
Merkin, Miri
Ishay, Yaron
Weinstein, Jean M.
Cafri, Carlos
description Background and Aim Revascularization guidelines support routine Heart Team (HT) discussion of appropriate patients. The effect of HT on decision making and clinical outcomes has not been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease (CAD) referred for HT discussion between 2016 and 2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005 and 2015 (No HT group). Results There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery score (2.5 ± 3 vs 3 ± 3; P = .32) and the mean SYNTAX score was low and similar in both groups (21 ± 6 vs 19 ± 6; P = .59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the No HT group (P 
doi_str_mv 10.1111/jocs.14892
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The effect of HT on decision making and clinical outcomes has not been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease (CAD) referred for HT discussion between 2016 and 2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005 and 2015 (No HT group). Results There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery score (2.5 ± 3 vs 3 ± 3; P = .32) and the mean SYNTAX score was low and similar in both groups (21 ± 6 vs 19 ± 6; P = .59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the No HT group (P &lt; .01). HT discussion led to a significant delay to PCI (8 ± 5 vs 1.8 ± 4 days; P = .02), while surgical revascularization times were not affected. Conclusion HT discussion in patients with multivessel CAD was associated with an increased referral to CABG but led to a significant delay in revascularization by angioplasty. The impact of these findings on patient satisfaction and outcome should be further investigated.</description><identifier>ISSN: 0886-0440</identifier><identifier>EISSN: 1540-8191</identifier><identifier>DOI: 10.1111/jocs.14892</identifier><language>eng</language><subject>complex coronary artery disease ; Heart Team discussion ; revascularization method</subject><ispartof>Journal of cardiac surgery, 2020-10, Vol.35 (10), p.2719-2724</ispartof><rights>2020 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3422-2f9406b19be53224728a25a67b9768d5ec3c52ddbcaefab51fbe45863451bdd93</citedby><cites>FETCH-LOGICAL-c3422-2f9406b19be53224728a25a67b9768d5ec3c52ddbcaefab51fbe45863451bdd93</cites><orcidid>0000-0002-7858-737X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjocs.14892$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjocs.14892$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids></links><search><creatorcontrib>Kezerle, Louise</creatorcontrib><creatorcontrib>Yohanan, Eli</creatorcontrib><creatorcontrib>Cohen, Avshalom</creatorcontrib><creatorcontrib>Merkin, Miri</creatorcontrib><creatorcontrib>Ishay, Yaron</creatorcontrib><creatorcontrib>Weinstein, Jean M.</creatorcontrib><creatorcontrib>Cafri, Carlos</creatorcontrib><title>The impact of Heart Team discussion on decision making for coronary revascularization in patients with complex coronary artery disease</title><title>Journal of cardiac surgery</title><description>Background and Aim Revascularization guidelines support routine Heart Team (HT) discussion of appropriate patients. The effect of HT on decision making and clinical outcomes has not been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease (CAD) referred for HT discussion between 2016 and 2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005 and 2015 (No HT group). Results There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery score (2.5 ± 3 vs 3 ± 3; P = .32) and the mean SYNTAX score was low and similar in both groups (21 ± 6 vs 19 ± 6; P = .59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the No HT group (P &lt; .01). HT discussion led to a significant delay to PCI (8 ± 5 vs 1.8 ± 4 days; P = .02), while surgical revascularization times were not affected. Conclusion HT discussion in patients with multivessel CAD was associated with an increased referral to CABG but led to a significant delay in revascularization by angioplasty. 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The effect of HT on decision making and clinical outcomes has not been explored. The aim of our study is to investigate the impact of the HT on the mode and delay to revascularization. Methods We compared data from a prospective cohort of consecutive patients with multivessel coronary artery disease (CAD) referred for HT discussion between 2016 and 2017 (HT group) with a historic control group of patients matched according to clinical and angiographic characteristics treated between 2005 and 2015 (No HT group). Results There were 93 patients in each group. The HT group and the No HT groups had a similar rate of ACS as well as cardiovascular risk factors and significant left ventricular (LV) dysfunction. No difference was observed in the mean Society of Thoracic Surgery score (2.5 ± 3 vs 3 ± 3; P = .32) and the mean SYNTAX score was low and similar in both groups (21 ± 6 vs 19 ± 6; P = .59). The treatment recommendations changed greatly, with 63% of patients being referred for coronary artery bypass grafting (CABG) after HT discussion but only 23% in the No HT group (P &lt; .01). HT discussion led to a significant delay to PCI (8 ± 5 vs 1.8 ± 4 days; P = .02), while surgical revascularization times were not affected. Conclusion HT discussion in patients with multivessel CAD was associated with an increased referral to CABG but led to a significant delay in revascularization by angioplasty. The impact of these findings on patient satisfaction and outcome should be further investigated.</abstract><doi>10.1111/jocs.14892</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7858-737X</orcidid><oa>free_for_read</oa></addata></record>
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subjects complex coronary artery disease
Heart Team discussion
revascularization method
title The impact of Heart Team discussion on decision making for coronary revascularization in patients with complex coronary artery disease
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