Antonis N Pavlidis1, Divaka Perera2, Grigoris V Karamasis3, Vinayak Bapat4, Chris Young4, Brian R Clapp1, Chris Blauth4, James Roxburgh4, Martyn R Thomas1, Simon R Redwood2. 1. Department of Cardiology, St. Thomas' Hospital, London, UK. 2. Cardiovascular Division, St. Thomas' Hospital Campus, King's College, London, UK. 3. Department of Cardiology, St. Thomas' Hospital, London, UK; Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK. Electronic address: grigoris.karamasis@gmail.com. 4. Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK.
Abstract
BACKGROUND: A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation. METHODS: We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making. RESULTS: The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced. CONCLUSIONS: The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account.
BACKGROUND: A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation. METHODS: We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making. RESULTS: The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced. CONCLUSIONS: The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account.
Authors: Tiffany Patterson; Hannah Z R McConkey; Fiyyaz Ahmed-Jushuf; Konstantinos Moschonas; Hanna Nguyen; Grigoris V Karamasis; Divaka Perera; Brian R Clapp; James Roxburgh; Christopher Blauth; Christopher P Young; Simon R Redwood; Antonis N Pavlidis Journal: J Am Heart Assoc Date: 2019-04-16 Impact factor: 5.501
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: Alexandru Burlacu; Adrian Covic; Mircea Cinteza; Paula Madalina Lupu; Radu Deac; Grigore Tinica Journal: Cardiovasc Ther Date: 2020-01-04 Impact factor: 3.023
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