Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania2Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania3Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
JAMA Surg. 2014 Nov;149(11):1109-12. doi: 10.1001/jamasurg.2014.2059.
Since the advent of transcatheter aortic valve replacement, the multidisciplinary heart team (MHT) approach has rapidly become the standard of care for patients undergoing the procedure. However, little is known about the potential effect of MHT on patients with coronary artery disease (CAD).
To determine the safety and efficacy of implementing the MHT approach for patients with complex CAD.
DESIGN, SETTING, AND PARTICIPANTS: Observational cohort pilot study of 180 patients with CAD involving more than 1 vessel in a single major academic tertiary/quaternary medical center. From May 1, 2012, through May 31, 2013, MHT meetings were convened to discuss evidence-based management of CAD. All cases were reviewed by a team of interventional cardiologists and cardiac surgeons within 72 hours of angiography. All clinical data were reviewed by the team to adjudicate optimal treatment strategies. Final recommendations were based on a consensus decision. Outcome measures were tracked for all patients to determine the safety and efficacy profile of this pilot program.
Multidisciplinary heart team meeting.
Thirty-day periprocedural mortality and rate of major adverse cardiac events.
Most of the patients underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG); a small percentage of patients underwent a hybrid procedure or medical management. Incidence of 30-day periprocedural mortality was low across all groups of patients (PCI group, 5 of 64 [8%]; CABG group, 1 of 87 [1%]). The rate of major adverse cardiac events during a median follow-up of 12.1 months ranged from 12 of 87 patients (14%) in the CABG group to 15 of 64 (23%) in the PCI group.
Outcomes of patients with complex CAD undergoing the optimal treatment strategy recommended by the MHT were similar to those of published national standards. Implementation of the MHT approach for patients with complex CAD is safe and efficacious.
自经导管主动脉瓣置换术问世以来，多学科心脏团队（MHT）方法已迅速成为接受该手术患者的标准护理方法。然而，对于患有冠状动脉疾病（CAD）的患者，MHT 方法的潜在影响知之甚少。
确定为患有复杂 CAD 的患者实施 MHT 方法的安全性和有效性。
设计、设置和参与者：在一家主要的学术三级/四级医疗中心，对涉及单一主要血管的 180 例 CAD 患者进行了观察性队列研究。从 2012 年 5 月 1 日至 2013 年 5 月 31 日，召开了 MHT 会议，以讨论 CAD 的循证管理。所有病例均在血管造影后 72 小时内由一组介入心脏病专家和心脏外科医生进行审查。团队审查了所有临床数据，以判断最佳治疗策略。最终建议基于共识决定。对所有患者进行了跟踪以确定该试点计划的安全性和有效性。
多学科心脏团队会议。
30 天围手术期死亡率和主要不良心脏事件发生率。
大多数患者接受了经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）；少数患者接受了杂交手术或药物治疗。所有患者组的 30 天围手术期死亡率均较低（PCI 组 64 例中的 5 例[8%]；CABG 组 87 例中的 1 例[1%]）。在中位随访 12.1 个月期间，CABG 组的 87 例患者中有 12 例（14%）和 PCI 组的 64 例患者中有 15 例（23%）发生了主要不良心脏事件。
接受 MHT 推荐的最佳治疗策略的复杂 CAD 患者的结局与已发表的国家标准相似。为患有复杂 CAD 的患者实施 MHT 方法是安全有效的。
