1. Multidisciplinary Heart Team Approach for Complex Coronary Artery Disease: Single Center Clinical Presentation
- Author
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Farouc A. Jaffer, Michael N. Young, Eugene Pomerantsev, Dhaval Kolte, Elizabeth Laikhter, Thoralf M. Sundt, Michael A. Fifer, Kevin Sinclair, Mary E. Cadigan, and Robert W. Yeh
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Health Status ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Single Center ,Coronary Angiography ,Workflow ,Coronary artery disease ,0302 clinical medicine ,Multidisciplinary approach ,Risk Factors ,heart team ,030212 general & internal medicine ,Prospective Studies ,Cooperative Behavior ,Coronary Artery Bypass ,Original Research ,Aged, 80 and over ,Cardiovascular Surgery ,Middle Aged ,team‐based care ,Cardiac surgery ,Treatment Outcome ,Editorial ,Female ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Clinical Decision-Making ,Revascularization ,Risk Assessment ,Decision Support Techniques ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Heart team ,medicine ,Humans ,Intensive care medicine ,Aged ,Patient Care Team ,business.industry ,Editorials ,Percutaneous coronary intervention ,Cardiovascular Agents ,medicine.disease ,Treatment ,Interdisciplinary Communication ,business ,Boston - Abstract
Background The Heart Team approach is ascribed a Class I recommendation in contemporary guidelines for revascularization of complex coronary artery disease. However, limited data are available regarding the decision‐making and outcomes of patients based on this strategy. Methods and Results One hundred sixty‐six high‐risk coronary artery disease patients underwent Heart Team evaluation at a single institution between January 2015 and November 2018. We prospectively collected data on demographics, symptoms, Society of Thoracic Surgeons Predicted Risk of Mortality/Synergy Between PCI with Taxus and Cardiac Surgery ( STS ‐ PROM / SYNTAX ) scores, mode of revascularization, and outcomes. Mean age was 70.0 years; 122 (73.5%) patients were male. Prevalent comorbidities included diabetes mellitus (51.8%), peripheral artery disease (38.6%), atrial fibrillation (27.1%), end‐stage renal disease on dialysis (13.3%), and chronic obstructive pulmonary disease (21.7%). Eighty‐seven (52.4%) patients had New York Heart Association III ‐ IV and 112 (67.5%) had Canadian Cardiovascular Society III ‐ IV symptomatology. Sixty‐seven (40.4%) patients had left main and 118 (71.1%) had 3‐vessel coronary artery disease. The median STS ‐ PROM was 3.6% (interquartile range 1.9, 8.0) and SYNTAX score was 26 (interquartile range 20, 34). The median number of physicians per Heart Team meeting was 6 (interquartile range 5, 8). Seventy‐nine (47.6%) and 49 (29.5%) patients underwent percutaneous coronary intervention and coronary artery bypass grafting, respectively. With increasing STS ‐ PROM (low, intermediate, high operative risk), coronary artery bypass graft was performed less often (47.9%, 18.5%, 15.2%) and optimal medical therapy was recommended more often (11.3%, 18.5%, 30.3%). There were no trends in recommendation for coronary artery bypass graft, percutaneous coronary intervention, or optimal medical therapy by SYNTAX score tertiles. In‐hospital and 30‐day mortality was 3.9% and 4.8%, respectively. Conclusions Integrating a multidisciplinary Heart Team into institutional practice is feasible and provides a formalized approach to evaluating complex coronary artery disease patients. The comprehensive assessment of surgical, anatomical, and other risk scores using a decision aid may guide appropriate, evidence‐based management within this team‐based construct.
- Published
- 2020