Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Thorac Cardiovasc Surg. 2018 Mar;155(3):865-873.e3. doi: 10.1016/j.jtcvs.2017.09.144. Epub 2017 Nov 9.
The regional needs and consolidation of cardiac surgery services (CSS) result in an increased number of stand-alone interventional cardiology units. We aimed to explore the impact of a heart team on the decision making and outcomes of patients with multivessel coronary artery disease referred for coronary revascularization in stand-alone interventional cardiology units.
This prospective study included 1063 consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention (PCI), with or without on-site CSS.
Of the 1063 patients, 487 (46%) underwent coronary artery bypass grafting (CABG) and 576 (54%) underwent PCI. A higher proportion of patients underwent PCI in hospitals without on-site CSS compared with those with on-site CSS (65% vs 46%; P < .001). Furthermore, patients referred to CABG from hospitals without on-site CSS had a significantly higher mean SYNTAX score compared with those who underwent CABG in centers with on-site CSS (29 vs 26; P = .018). Multivariate logistic regression analysis consistently showed that the absence of on-site cardiac surgery and a heart team was independently associated with a 2.5-fold increased likelihood for predicting the referral of PCI rather than CABG (odds ratio, 2.54; 95% confidence interval, 1.8-3.6).
Patients with multivessel coronary artery disease treated in centers without on-site cardiac surgery services receive a lower rate of appropriate guideline-based intervention with CABG. These findings suggest that a heart team approach should be mandatory even in centers with stand-alone interventional cardiology units.
心脏手术服务（CSS）的区域需求和整合导致独立介入心脏病学单位的数量增加。我们旨在探讨心脏团队对多支冠状动脉疾病患者的决策和结果的影响，这些患者被转诊到独立介入心脏病学单位进行冠状动脉血运重建。
这项前瞻性研究纳入了 2013 年 1 月至 4 月期间，来自以色列所有 22 家进行冠状动脉造影和经皮冠状动脉介入治疗（PCI）的医院的 1063 例连续多支血管疾病患者，这些医院或有或没有现场 CSS。
在 1063 例患者中，487 例（46%）接受冠状动脉旁路移植术（CABG），576 例（54%）接受 PCI。与有现场 CSS 的医院相比，无现场 CSS 的医院接受 PCI 的患者比例更高（65%比 46%；P<.001）。此外，与在有现场 CSS 的中心接受 CABG 的患者相比，从无现场 CSS 的医院转诊接受 CABG 的患者的平均 SYNTAX 评分显著更高（29 比 26；P=.018）。多变量逻辑回归分析一致表明，无现场心脏手术和心脏团队与预测 PCI 而非 CABG 转诊的可能性增加 2.5 倍独立相关（优势比，2.54；95%置信区间，1.8-3.6）。
在没有现场心脏手术服务的中心治疗的多支冠状动脉疾病患者接受基于指南的适当 CABG 干预的比例较低。这些发现表明，即使在拥有独立介入心脏病学单位的中心，心脏团队方法也应是强制性的。
