Ali Montasir, Ionescu Adrian, Bakhsh Abdul R A, Elsayegh Omer, Al-Sadi Hussain
Specialist Registrar in Cardiology.
Consultant Cardiologist Morriston Cardiac Centre, Morriston, Swansea, SA6 6NL.
Br J Cardiol. 2023 Nov 29;30(4):42. doi: 10.5837/bjc.2023.042. eCollection 2023.
Guidelines recommend decision- making using the heart team (HT) in complex patients considered for myocardial revascularisation, but there are little data on how this approach works in practice. We data-mined our electronic HT database and selected patients in whom the clinical question referred to revascularisation, and documented HT recommendations and their implementation. We identified 154 patients (117 male), mean age 68.9 ± 11.4 years, discussed between February 2019 and December 2020. The clinical questions were coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) (141 cases, 91%), and medical treatment versus revascularisation by PCI (eight cases, 6%) or by CABG (five cases, 3%). HT recommended CABG in 55 cases (35%), PCI in 43 (28%), medical treatment in 15 (10%), and equipoise in seven (5%) and further investigations in 34 (22%): non-invasive imaging for ischaemia in 11 (32%), invasive coronary physiology studies in eight (24%), further clinical assessment in seven (20%), structural imaging for five (15%), invasive coronary angiography in two (6%), and an electrophysiology opinion in one case (3%). Decisions were implemented in 135 cases (89%). The average time between the HT and the implementation of its decision was 80.5 ± 129.3 days. There were 17 deaths: 10 cardiac, six non- cardiac and one of unknown cause. Patients who survived were younger (68.6 ± 11.3 years) than those who died (73.8 ± 10.0 years, p = 0.03). In conclusion, almost 90% of the decisions of the HT on myocardial revascularisation are implemented, while ischaemia testing is the main investigation required for decision- making. Recent data on the futility of such an approach have not yet permeated clinical practice.
指南建议，对于考虑进行心肌血运重建的复杂患者，应通过心脏团队（HT）进行决策，但关于这种方法在实际中如何运作的数据很少。我们对电子HT数据库进行了数据挖掘，选择了临床问题涉及血运重建的患者，并记录了HT的建议及其实施情况。我们确定了154例患者（117例男性），平均年龄68.9±11.4岁，于2019年2月至2020年12月期间进行了讨论。临床问题包括冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）（141例，91%），以及药物治疗与PCI（8例，6%）或CABG（5例，3%）血运重建的比较。HT建议CABG 55例（35%），PCI 43例（28%），药物治疗15例（10%），平衡7例（5%），进一步检查34例（22%）：11例（32%）进行缺血的非侵入性成像，8例（24%）进行有创冠状动脉生理学研究，7例（20%）进行进一步临床评估，5例（15%）进行结构成像，2例（6%）进行有创冠状动脉造影，1例（3%）进行电生理评估。135例（89%）的决策得到了实施。HT做出决策与实施决策之间的平均时间为80.5±129.3天。有17例死亡：10例心脏相关，6例非心脏相关，1例死因不明。存活患者（68.6±11.3岁）比死亡患者（73.8±10.0岁，p = 0.03）年轻。总之，HT关于心肌血运重建的决策几乎90%得到了实施，而缺血检测是决策所需主要检查。关于这种方法无效性的最新数据尚未渗透到临床实践中。
