Pickering Taylor, Kluis Austin, Shih Emily, Squiers John J, McCullough Kyle, Dorton Cody, Moore David O, Potluri Srinivasa P, Szerlip Molly, Al-Azizi Karim, Moubarak Ghadi, Ladner Jonathan, Vaishnav Radhika, McCoy Shelby, Ejiofor Julius, Sawhney Rahul, Hale Sarah, Schaffer Justin M, Banwait Jasjit, Harrington Katherine B, Brinkman William T, Hafen Lee R, Smith Robert L, George Timothy J, DiMaio J Michael, Ryan William H, Hutcheson Kelley A
Baylor Scott & White Research Institute, Plano, Texas, USA.
Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas, USA.
Proc (Bayl Univ Med Cent). 2025 Jun 20;38(5):589-597. doi: 10.1080/08998280.2025.2516981. eCollection 2025.
Guidelines recommend a multidisciplinary heart team approach for managing complex coronary artery disease (CAD), yet its impact on clinical outcomes and adherence to recommendations is rarely reported.
Between June 2021 and August 2022, 210 high-risk patients with isolated, complex CAD were evaluated at our institution's weekly heart team conference for consideration of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), hybrid PCI/CABG, or optimal medical therapy (OMT). Adherence to recommendations and clinical outcomes, including 30-day, 1-year, and 2-year mortality, were assessed.
Overall adherence to heart team recommendations was 92%, with 96% adherence for CABG, 90% for PCI, 87% for OMT, and 75% for hybrid PCI/CABG. CABG was the most frequently recommended treatment (53%) and demonstrated the lowest mortality at 1 year (4%) and 2 years (6%) compared with PCI (1 year, 28%; 2 year, 40%) and OMT (1 year, 10%; 2 year, 20%). CABG patients had a lower-than-expected mortality (observed-to-expected ratio 0.9), while PCI was associated with significantly higher mortality (observed-to-expected ratio 3.0).
This single-center multidisciplinary heart team approach for complex CAD offers a collaborative, patient-centered model that facilitates high adherence rates and favorable patient outcomes. These findings highlight the potential benefits of integrating multidisciplinary evaluation and support its implementation into standard practice for high-risk CAD patients.
指南推荐采用多学科心脏团队方法来管理复杂冠状动脉疾病（CAD），但其对临床结局和推荐意见依从性的影响鲜有报道。
在2021年6月至2022年8月期间，在我们机构每周的心脏团队会议上对210例孤立性、复杂性CAD高危患者进行评估，以考虑冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）、杂交PCI/CABG或最佳药物治疗（OMT）。评估对推荐意见的依从性和临床结局，包括30天、1年和2年死亡率。
对心脏团队推荐意见的总体依从率为92%，CABG的依从率为96%，PCI为90%，OMT为87%，杂交PCI/CABG为75%。CABG是最常被推荐的治疗方法（53%），与PCI（1年，28%；2年，40%）和OMT（1年，10%；2年，20%）相比，其1年（4%）和2年（6%）死亡率最低。CABG患者的死亡率低于预期（观察到的与预期的比率为0.9），而PCI则与显著更高的死亡率相关（观察到的与预期的比率为3.0）。
这种针对复杂CAD的单中心多学科心脏团队方法提供了一种协作性、以患者为中心的模式，有助于提高依从率并使患者获得良好结局。这些发现凸显了整合多学科评估的潜在益处，并支持将其纳入高危CAD患者的标准治疗实践中。
