Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach—Insights from Tertiary Cardiovascular Care Center

Abstract

Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) follow-up of 37 (14) months of patients with severe CAD (three-vessel [3-VD] or/and left main [LM] disease) qualified after MHT discussion to optimal medical treatment (OMT) alone, OMT and coronary artery bypass grafting (CABG), or OMT and percutaneous coronary intervention (PCI) were evaluated. As the primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) (i.e., death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) were considered. Result: From 2016 to 2019, 176 MHT meetings were held, and a total of 1286 participants with severe CAD and completely implemented MHT decisions (OMT, CABG, or PCI for 251, 356, and 679 patients, respectively) were included. The occurrence of the primary endpoint was significantly increased in OMT-group (154 (61.4%) vs. CABG and PCI groups—110 (30.9%) and 302 (44.5%) patients, respectively (p < 0.05). For interventional strategies only—CABG was associated with reduced rates of MACCE and repeat revascularization, while the superiority of PCI for stroke and disabling stroke was observed (p < 0.05). The general health status assessed at the end of the follow-up was significantly better for patients who underwent CABG or PCI than in the OMT group (p < 0.05). Conclusions: In this real-life study, we presented a single-center experience of providing optimal medical care for patients with severe CAD following MHT discussion.

Heart team consultations for patients with severe coronary artery disease or valvular heart disease in the era of the COVID-19 pandemic: a single-center experience

“…The inclusion criteria for patients presented during HT meetings were as follows: aged ≥18 years and complete clinical, echocardiographic, and angiographic characteristics. Furthermore, the angiographic and echocardiographic inclusion criteria for severe CAD, severe AS, and severe MR were reported previously ( 7 – 9 ). The optimal medical therapy (OMT) was defined as using of drugs with proven impact on increased survival or providing optimal reduction of the signs and symptoms associated with CAD or VHD.…”

Five-year outcomes in patients with multivessel coronary artery disease undergoing surgery or percutaneous intervention.

“…After implementing surgery of percutaneous approach all of patients were followed with OMT de ned as using of drugs with proven impact on survival or reducing symptoms of CAD -aspirin or dual antiplatelet therapy (DAPT), angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), beta-blockers (BB), statins and aldosterone antagonists. The de nitions of chronic kidney disease (CKD), severe pulmonary arterial hypertension (PAH) and anemia were also described previously [14]. 3-VD was de ned as stenosis greater than 70% or between 40-70%, but assessed with functional tests (fractional ow reserve (FFR), instantaneous wave-free ratio (iwFR) or quantitative ow ratio (QFR)) as haemodynamically signi cant in at least three vessels with 1.5 mm or more in diameter, while the LMD was de ned as LM stenosis equal or more than 50%.…”

“…The detailed methods and study plan have already been described earlier [14]. Brie y, this single-center observational study was conducted in the 1 st Department of Cardiology, Medical University of Warsaw, a large tertiary cardiovascular care center in Poland.…”

“…The inclusion criteria were: aged ≥ 18 years and complete clinical, echocardiographic and angiographic characteristics. The exclusion criteria included the following: pregnancy/lactation, disseminated neoplastic process, life expectancy < 1 year and lack of informed, written consent [14]. All of patients were evaluated by a HT composed of interventional cardiologists, cardiac surgeons, clinical cardiologists and non-invasive imaging specialists and quali ed to one of three main strategies: CABG with OMT, PCI with OMT or OMT alone [14].…”

An Individualized Approach of Multidisciplinary Heart Team for Myocardial Revascularization and Valvular Heart Disease—State of Art

“…The general health status assessed at the end of follow-up was significantly more satisfactory for patients who underwent revascularization than in OMT-group ( p < 0.05) [ 23 ]. Current evidence summarizing the role of HT for treating patients with CAD is presented in Table 1 .…”