Long-term survival after multidisciplinary heart team-guided management of complex coronary artery disease.

Q3 Medicine

Baylor University Medical Center Proceedings Pub Date : 2025-06-20 eCollection Date: 2025-01-01 DOI:10.1080/08998280.2025.2516981

Taylor Pickering, Austin Kluis, Emily Shih, John J Squiers, Kyle McCullough, Cody Dorton, David O Moore, Srinivasa P Potluri, Molly Szerlip, Karim Al-Azizi, Ghadi Moubarak, Jonathan Ladner, Radhika Vaishnav, Shelby McCoy, Julius Ejiofor, Rahul Sawhney, Sarah Hale, Justin M Schaffer, Jasjit Banwait, Katherine B Harrington, William T Brinkman, Lee R Hafen, Robert L Smith, Timothy J George, J Michael DiMaio, William H Ryan, Kelley A Hutcheson

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引用次数: 0

Abstract

Objective: Guidelines recommend a multidisciplinary heart team approach for managing complex coronary artery disease (CAD), yet its impact on clinical outcomes and adherence to recommendations is rarely reported.

Methods: Between June 2021 and August 2022, 210 high-risk patients with isolated, complex CAD were evaluated at our institution's weekly heart team conference for consideration of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), hybrid PCI/CABG, or optimal medical therapy (OMT). Adherence to recommendations and clinical outcomes, including 30-day, 1-year, and 2-year mortality, were assessed.

Results: Overall adherence to heart team recommendations was 92%, with 96% adherence for CABG, 90% for PCI, 87% for OMT, and 75% for hybrid PCI/CABG. CABG was the most frequently recommended treatment (53%) and demonstrated the lowest mortality at 1 year (4%) and 2 years (6%) compared with PCI (1 year, 28%; 2 year, 40%) and OMT (1 year, 10%; 2 year, 20%). CABG patients had a lower-than-expected mortality (observed-to-expected ratio 0.9), while PCI was associated with significantly higher mortality (observed-to-expected ratio 3.0).

Conclusion: This single-center multidisciplinary heart team approach for complex CAD offers a collaborative, patient-centered model that facilitates high adherence rates and favorable patient outcomes. These findings highlight the potential benefits of integrating multidisciplinary evaluation and support its implementation into standard practice for high-risk CAD patients.

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复杂冠状动脉疾病多学科心内科指导治疗后的长期生存率。

目的：指南推荐多学科心脏团队方法治疗复杂冠状动脉疾病（CAD），但其对临床结果和依从性的影响很少报道。方法：在2021年6月至2022年8月期间，在我院每周心脏小组会议上对210例孤立的复杂CAD高危患者进行评估，考虑冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）、PCI/CABG混合治疗或最佳药物治疗（OMT）。对建议的依从性和临床结果进行评估，包括30天、1年和2年死亡率。结果：心脏小组建议的总体依从性为92%，其中CABG的依从性为96%，PCI为90%，OMT为87%，混合PCI/CABG为75%。CABG是最常被推荐的治疗方法（53%），与PCI（1年，28%；2年，40%）和OMT（1年，10%；2年，20%）相比，CABG在1年（4%）和2年（6%）的死亡率最低。CABG患者的死亡率低于预期（观察预期比为0.9），而PCI患者的死亡率明显高于预期（观察预期比为3.0）。结论：这种针对复杂CAD的单中心多学科心脏团队方法提供了一种协作的、以患者为中心的模式，促进了高依从率和良好的患者预后。这些发现强调了整合多学科评估的潜在益处，并支持将其纳入高危CAD患者的标准实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Baylor University Medical Center Proceedings Medicine-Medicine (all)

CiteScore

1.30

自引率

0.00%

发文量

245