The Impact of Heart Team Discussion on Decision Making for Coronary Revascularization in Patients with Multivessel Coronary Artery Disease. Something New is Happening - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Eli Yohanan Cardiology, Soroka Medical Center, Be'er Sheva, Israel Louise Kezerle Cardiology, Soroka Medical Center, Be'er Sheva, Israel Avshalom Cohen Cardiology, Soroka Medical Center, Be'er Sheva, Israel Miri Merkin Cardiology, Soroka Medical Center, Be'er Sheva, Israel Rosenstein Gabriel Cardiology, Soroka Medical Center, Be'er Sheva, Israel Yaron Ishay Cardiology, Soroka Medical Center, Be'er Sheva, Israel John Mark Weinstein Cardiology, Soroka Medical Center, Be'er Sheva, Israel Yuri Kalishian Cardiology, Soroka Medical Center, Be'er Sheva, Israel Gideon Sa'ar Cardiology, Soroka Medical Center, Be'er Sheva, Israel Doron Zahger Cardiology, Soroka Medical Center, Be'er Sheva, Israel Carlos Cafri Cardiology, Soroka Medical Center, Be'er Sheva, Israel

Background: Current revascularization guidelines support routine heart team (HT) discussion of appropriate patients. The impact of this strategy on decision making and on clinical outcomes has not been widely investigated.

Aim: To investigate the influence of the HT on the mode of revascularization and on the delay to revascularization.

Methods: We analyzed data from a registry (HT group) of patients with complex coronary artery disease selected for heart team discussion (82 pts, aged 67±12 years) compared with matched patients catheterized between 2005-2015 (81 pts, 65±11 years) and managed without HT discussion (No HT group ). Clinical and angiographic characteristics, STS and Syntax score, recommended revascularization and delay to treatment were analyzed

Results: Both groups had a similar high rate of ACS (96% vs 95%) as well as of risk factors (DM=58% vs.50%, hypertension=74%vs.86%, smoking=41%vs.54%). The No HT group had more previous PCI (27% vs.42%, p=0.04) and PVD (5% vs.27% P =0.04). Moderate to severe LV dysfunction (33% vs. 32%) and multivessel disease rate (88% vs.88%) were similar. The mean STS score (3± 4 vs. 4 ±4 p=0.9) and the prevalence of moderate and high risk STS groups (25% vs 38%) were similar. The mean Syntax score was low in both groups but higher in the No HT group (18±8 vs.22±8 p=0.05). The treatment in the HT group was PCI=37%, CABG=61%, Medical=2%, as compared to PCI=72%, CABG=21%, Medical=6% in the No HT group, p<0.01). HT discussion group had a significant delay to revascularization (7±5 vs. 2±4 days p=0.02).

Conclusion: Heart Team discussion prior to revascularization in patients with complex coronary artery disease was associated with an increasing use of CABG rather than PCI and with a significant delay to revascularization. The impact of these findings on patient satisfaction and outcome should be further investigated.