INTRODUCTION
Treatment based on multidisciplinary decision making is the cornerstone of current patient-centered therapeutics in certain medical fields such as oncology [1]. Recently, this approach has also been applied to the field of coronary interventions. The decision-making process leading to coronary revascularization is straightforward in many clinical and angiographic settings, and recommendation for either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) can be made in the catheterization laboratory immediately after the diagnostic coronary angiogram. However, many patients presenting with comorbidities or/and complex coronary anatomy may require a more global assessment in order to choose the optimal revascularization strategy.
The SYNTAX score was developed to grade the severity of coronary lesions based on objective anatomical criteria [2]. This score was validated in a cohort of stable coronary patients, and a higher score reflects more complex disease and a greater risk for percutaneous interventions, indicating a preference for CABG over PCI [3, 4]. This score, however, being purely anatomical, still fails to describe the level of risk and benefit to the specific patient, which comprise an intricate interplay between demographic, clinical and anatomical characteristics. These difficulties led to the understanding that the treatment of the patient with multivessel or high risk coronary artery disease should be individualized [5]. For this purpose, the 2010 European Society of Cardiology (ESC) on coronary revascularization introduced the concept of a Heart Team (HT), composed of cardiac surgeons, clinical cardiologists and interventional cardiologists. [6] Nonetheless, this recommendation is based on expert opinion and the impact of this strategy on the decision making process and specially on clinical outcomes has not been widely investigated.
Since 2015, the Soroka University Medical Center, a tertiary hospital in Southern Israel has implemented an institutional protocol regarding which patients should be brought for HT discussion. The main purpose of this study is to examine the influence of the HT discussion on the selection of the revascularization approach as well on the delay to revascularization. Furthermore, we sought to evaluate the concordance between the HT-recommended treatment of choice with the initial approach suggested by the interventional cardiologist upon finishing the diagnostic angiogram.
MATERIALS AND METHODS