Abstract 11758: The Heart Team: Myth Vs. Reality

INTRODUCTION: The management of patients with complex CAD has led to the development of a heart team strategy involving shared decision making by a multidisciplinary team. Both the 2010 ESC/EACTS Guidelines and the 2012 AHA/ACC Criteria consider a heart team evaluation to be a class 1 indication to determine the treatment of patients with LM and/or 3VD prior to PCI. This study assessed our single institution’s compliance with this strategy. METHODS: Since July, 2012 patients with LM and/or 3VD or multi-vessel restenosis following prior PCI were recommended to have a multidisciplinary heart team discussion prior to any treatment. From November 1, 2012 through April 30, 2014 the results and therapeutic outcomes of all diagnostic cardiac catheterizations were analyzed. The total number of patients meeting criteria for a heart team evaluation, those actually having such a discussion and the subsequent treatment pathways were assessed. RESULTS: During the 18 month study period, 5740 patients underwent diagnostic cardiac catheterization. Of these, 522 patients met criteria for a heart team evaluation. A total of 266 patients (51%) were discussed by the heart team prior to treatment. Of this group, 153 patients received CABG (58%), 101 patients received PCI (38%), and 12 patients received medical management (5%). A total of 256 patients (49%) were not submitted for evaluation by the heart team. Of this group, 3 patients received CABG (1%), 227 received PCI (89%) and 26 received medical management (10%). The total PCI:CABG ratio for all patients was 17:1 and the total PCI:CABG ratio for those 522 patients with LM and/or 3VD was 3:1. Of this group, for those undergoing a heart team evaluation, the PCI:CABG ratio was 0.7:1 and without an evaluation the PCI: CABG ratio was 76:1 (p<0.001). CONCLUSIONS: Despite established guidelines and a clinician consensus regarding the management strategy for complex CAD, half of eligible patients were not prospectively assessed by the heart team. When an evaluation was performed, the PCI:CABG ratio shifted from 76:1 to 0.7:1. Only through a collaborative process can optimal patient care be achieved.