Domingues Carina T, Milojevic Milan, Thuijs Daniel J F M, van Mieghem Nicolas M, Daemen Joost, van Domburg Ron T, Kappetein A Pieter, Head Stuart J
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Cardiology, Erasmus University Medical Center, Netherlands.
Interact Cardiovasc Thorac Surg. 2019 Feb 1;28(2):206-213. doi: 10.1093/icvts/ivy237.
The Heart Team has been recommended as standard care for patients with coronary artery disease (CAD). However, little is known about the real benefits, potential treatment delays and late outcomes of this approach. Our goal was to determine the safety and feasibility of multidisciplinary Heart Team decision making for patients with CAD.
We retrospectively assessed 1000 consecutive cases discussed by the Heart Team between November 2010 and January 2012. We assessed (i) time intervals between different care steps involving the Heart Team; (ii) the distribution of patients according to the complexity of their CAD; and (iii) the 5-year survival as estimated from Kaplan-Meier curves.
Of 1000 case discussions, 40 were repeat cases, resulting in 960 unique cases. The mean age was 65 years, 73% were men, and 29% had diabetes. Native vessel disease was present in 86.4%, of which 69% had simple 1-vessel disease (1VD) or 2-vessel disease (2VD), and 31% had complex left main (LM) or 3-vessel disease (3VD). The time interval between referral by a community hospital and final treatment was less than 6 weeks for 90% of cases. Treatment decisions were delayed in 35% of cases due to a need for additional diagnostic information. For simple 1- or 2VD with or without proximal left anterior descending artery involvement, treatment was medical therapy in 6% and 12%, respectively; percutaneous coronary intervention (PCI) in 88% and 85%, respectively; and coronary artery bypass grafting (CABG) in 6% and 3%, respectively. For 3VD disease, treatment was equally split between CABG and PCI (46% for both). PCI was preferred for isolated LM or LM with 1VD (81% vs CABG 16%), whereas CABG was preferred in LM with 2- or 3VD (71% vs PCI 19%). The 5-year mortality rate was 16% for 1- or 2VD, 17% for 3VD, 3% for isolated LM or with 1VD and 27% for LM with 2- or 3VD.
In this single-centre analysis, the Heart Team approach was feasible, with decision making and treatment by the Heart Team following within a short time after referral. However, the timing of treatment could be further optimized if adequate information and imaging were available at the time of the Heart Team meeting. The final treatment recommendation by the Heart Team was largely in accordance with clinical guidelines.
心脏团队已被推荐作为冠心病（CAD）患者的标准治疗方式。然而，对于这种方法的实际益处、潜在治疗延迟和远期结局知之甚少。我们的目标是确定心脏团队多学科决策对CAD患者的安全性和可行性。
我们回顾性评估了2010年11月至2012年1月期间心脏团队讨论的1000例连续病例。我们评估了：（i）涉及心脏团队的不同治疗步骤之间的时间间隔；（ii）根据CAD复杂性对患者的分布情况；（iii）根据Kaplan-Meier曲线估计的5年生存率。
在1000例病例讨论中，40例为重复病例，因此有960例独特病例。平均年龄为65岁，73%为男性，29%患有糖尿病。86.4%存在天然血管疾病，其中69%患有简单的单支血管疾病（1VD）或双支血管疾病（2VD），31%患有复杂的左主干（LM）或三支血管疾病（3VD）。90%的病例从社区医院转诊到最终治疗的时间间隔不到6周。35%的病例因需要额外的诊断信息而导致治疗决策延迟。对于伴有或不伴有左前降支近端受累的简单1VD或2VD，分别有6%和12%的患者接受药物治疗；分别有88%和85%的患者接受经皮冠状动脉介入治疗（PCI）；分别有6%和3%的患者接受冠状动脉旁路移植术（CABG）。对于3VD疾病，CABG和PCI的治疗比例相同（均为46%）。孤立性LM或伴有1VD的LM首选PCI（81% vs CABG 16%），而伴有2VD或3VD的LM首选CABG（71% vs PCI 19%）。1VD或2VD的5年死亡率为16%，3VD为17%，孤立性LM或伴有1VD为3%，伴有2VD或3VD的LM为27%。
在这项单中心分析中，心脏团队方法是可行的，心脏团队在转诊后短时间内即可进行决策和治疗。然而，如果在心脏团队会议时能获得足够的信息和影像学资料，治疗时机可进一步优化。心脏团队的最终治疗建议在很大程度上符合临床指南。
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