Prognostic Impact of Implementation of Heart Team Approach on Cardiovascular Outcomes in Patients With Complex Coronary Artery Disease

Background

In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision-making, yet PCI remains prevalent.

Methods and Results

We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long-term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, n = 448) and without HTA (non-HTA group, n = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%).

Conclusion

A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients.