Carlos E Sanchez1, Anthony Dota2, Vinay Badhwar3, Dustin Kliner2, A J Conrad Smith2, Danny Chu3, Catalin Toma2, Lawrence Wei3, Oscar C Marroquin2, John Schindler2, Joon S Lee2, Suresh R Mulukutla4,5. 1. Department of Internal Medicine, Division of Cardiology, Riverside Methodist Hospital, Columbus, Ohio. 2. Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania. 4. Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. mulukutlasr@upmc.edu. 5. Department of Internal Medicine, Division of Cardiology, VA Medical Center, Pittsburgh, Pennsylvania. mulukutlasr@upmc.edu.
Abstract
OBJECTIVES: To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization. BACKGROUND: Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization. METHODS: From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App. RESULTS: Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P < 0.0001) and Society of Thoracic Surgeons-Predicted Risk of Mortality (6.1% ± 4.7%; 8.1% ± 6.3%; 3.7% ± 4.1%; P < 0.0081) compared to appropriate indications, frequently had concomitant forms of advanced comorbidities and frailty in the setting of symptomatic coronary artery disease. CONCLUSIONS: A formal, multidisciplinary revascularization heart team can provide proper validation for clinical decisions and should be considered in combination with the Appropriate Use Criteria for coronary revascularization to formulate revascularization strategies for individuals in a patient-centered fashion.
OBJECTIVES: To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization. BACKGROUND: Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization. METHODS: From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App. RESULTS: Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P < 0.0001) and Society of Thoracic Surgeons-Predicted Risk of Mortality (6.1% ± 4.7%; 8.1% ± 6.3%; 3.7% ± 4.1%; P < 0.0081) compared to appropriate indications, frequently had concomitant forms of advanced comorbidities and frailty in the setting of symptomatic coronary artery disease. CONCLUSIONS: A formal, multidisciplinary revascularization heart team can provide proper validation for clinical decisions and should be considered in combination with the Appropriate Use Criteria for coronary revascularization to formulate revascularization strategies for individuals in a patient-centered fashion.
Authors: Christoph T Starck; Frank Bracke; Peter-Paul Delnoy; Roger A Freedman; Andrzej Kutarski; Mark Gallagher; Morio Shoda; Robert Peyton; Manav Sohal; Frederik Gadler; Kamil Sedlacek; Juha Hartikainen; Patrizio Mazzone; Alexander Breitenstein; Nigel Lever Journal: Cardiol J Date: 2020-09-11 Impact factor: 3.487
Authors: Michael B Tsang; J D Schwalm; Sumeet Gandhi; Matthew G Sibbald; Amiram Gafni; Mathew Mercuri; Omid Salehian; Andre Lamy; Dan Pericak; Sanjit Jolly; Tej Sheth; Craig Ainsworth; James Velianou; Nicholas Valettas; Shamir Mehta; Natalia Pinilla; Bobby Yanagawa; Li Zhang; Victor Chu; Dominic Parry; Richard Whitlock; Adel Dyub; Irene Cybulsky; Lloyd Semelhago; Kostas Ioannou; Adnan Hameed; Douglas Wright; Amin Mulji; Saeed Darvish-Kazem; Nandini Gupta; Ahmed Alshatti; Madhu K Natarajan Journal: JAMA Netw Open Date: 2020-08-03
Authors: Michael N Young; Dhaval Kolte; Mary E Cadigan; Elizabeth Laikhter; Kevin Sinclair; Eugene Pomerantsev; Michael A Fifer; Thoralf M Sundt; Robert W Yeh; Farouc A Jaffer Journal: J Am Heart Assoc Date: 2020-04-20 Impact factor: 5.501