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