Sanchez Carlos E, Dota Anthony, Badhwar Vinay, Kliner Dustin, Smith A J Conrad, Chu Danny, Toma Catalin, Wei Lawrence, Marroquin Oscar C, Schindler John, Lee Joon S, Mulukutla Suresh R
Department of Internal Medicine, Division of Cardiology, Riverside Methodist Hospital, Columbus, Ohio.
Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Catheter Cardiovasc Interv. 2016 Oct;88(4):E103-E112. doi: 10.1002/ccd.26276. Epub 2015 Nov 3.
To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization.
Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization.
From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App.
Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P < 0.0001) and Society of Thoracic Surgeons-Predicted Risk of Mortality (6.1% ± 4.7%; 8.1% ± 6.3%; 3.7% ± 4.1%; P < 0.0081) compared to appropriate indications, frequently had concomitant forms of advanced comorbidities and frailty in the setting of symptomatic coronary artery disease.
A formal, multidisciplinary revascularization heart team can provide proper validation for clinical decisions and should be considered in combination with the Appropriate Use Criteria for coronary revascularization to formulate revascularization strategies for individuals in a patient-centered fashion. © 2015 Wiley Periodicals, Inc.
评估一个多学科血运重建心脏团队基于证据的全面临床评估，该评估针对使用SYNTAX评分结合胸外科医师协会得出的临床变量的复杂冠状动脉疾病患者的血运重建治疗决策，如何能增加冠状动脉血运重建适宜使用标准的利用率。
由于血运重建的不当过度使用，冠状动脉疾病血运重建的决策受到了严格审查。在常规临床实践中，几乎没有数据评估结构化的多学科心脏团队方法如何与血运重建适宜使用标准结合使用。
从2012年5月1日至2015年1月1日，召开了多学科血运重建心脏团队会议，以讨论301例复杂冠状动脉疾病患者的循证管理。使用心血管造影和介入学会的质量改进工具包（SCAI-QIT）适宜使用标准应用程序，针对每个临床场景，根据冠状动脉血运重建适宜使用标准对心脏团队的建议进行判定。
心脏团队与适宜使用标准的一致性显示，冠状动脉血运重建的主要适应证适宜率为99.3%。在接受经皮血运重建的患者中，34.9%的患者有心脏团队建议的不适当或不确定适应证。与适宜适应证相比，经皮冠状动脉介入治疗不确定或不适当的患者的SYNTAX评分显著更高（分别为27.3±6.6；28.5±5.5；19.2±6；P<0.0001），胸外科医师协会预测的死亡风险也显著更高（分别为6.1%±4.7%；8.1%±6.3%；3.7%±4.1%；P<0.0081），在有症状的冠状动脉疾病情况下，这些患者经常伴有多种晚期合并症和身体虚弱。
一个正式的多学科血运重建心脏团队可以为临床决策提供适当的验证，应考虑将其与冠状动脉血运重建适宜使用标准相结合，以患者为中心的方式为个体制定血运重建策略。©2015威利期刊公司
