Impact of Onsite Cardiac Surgery Service on Revascularization Strategy in Patients with Left Main and Multi-Vessel Coronary Artery Disease -
A Single Center Experience

Objectives: We aimed to show that the presence of an onsite cardiac surgery service working in tandem with cardiologists generates a collaborative heart team capable of providing a balanced, multidisciplinary decision-making process. The lack of such a team could potentially increase the number of percutaneous coronary interventions (PCI) for patients suffering from left main (LM) and multi-vessel coronary artery disease (MVCAD).

Methods: We compared 1166 patients with LM and MVCAD referred to either coronary artery bypass graft (CABG) or PCI before (September 2013-April 2015: Group A – 572 patients) and after (May 2015-December 2016: Group B – 594 patients) establishing a cardiac surgery service heart team in the Poria Medical Center. We also compared the readmission rates for acute myocardial infarction (AMI) and mortality in those patients who underwent CABG versus PCI between September 2013 and December 2016.

Results: There was no significant differences between the groups in mean patient age (66±12), gender (79% males), diabetes mellitus (47.4% vs. 47.8%, p=0.907) and chronic obstructive pulmonary disease (17.3% vs. 19.2%, p=0.448), but the number of patients referred to CABG in Group B (134/22.6%) was more than double that in Group A (64/11.2%) (p<0.001). The mortality rate of patients referred to PCI was significantly higher than those referred to CABG (13.5% vs. 3.5%, respectively; p<0.001). The readmission rate for AMI in patients who underwent PCI was higher (16/1.7%) than in those who underwent CABG (1/0.5%) (p=0.334).

Conclusions: At early and mid-term follow-up our results demonstrate the significance of having a collaborative heart team when treating LM and MVCAD patients. Both mortality rates (significantly so) and readmissions for AMI were higher in patient who underwent PCI compared with CABG. Based on our results, a heart team approach should be considered even in centers without onsite cardiac surgery services.