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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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[The heart team in planning and performance of revascularization : ESC guidelines versus clinical routine]

J-M Sinning1, A Welz2, G Nickenig3

  • 1Medizinische Klinik und Poliklinik II, Herzzentrum der Universität Bonn, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland. jan-malte.sinning@ukb.uni-bonn.de.

Herz
|September 7, 2016
PubMed

Insights

The heart team approach optimizes treatment decisions for coronary artery disease (CAD). Complex cases and acute coronary syndromes require multidisciplinary heart team review for best outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • The heart team, comprising cardiologists, cardiac surgeons, and interventional cardiologists, is crucial for managing coronary artery disease (CAD).
  • Standardized protocols can streamline decision-making for common CAD scenarios.
  • Complex cases often require a multidisciplinary approach beyond routine protocols.

Purpose of the Study:

  • To emphasize the importance of the heart team in managing coronary artery disease (CAD).
  • To outline decision-making processes for complex CAD cases, including those with high SYNTAX scores, diabetes, left main stem, or three-vessel disease.
  • To guide the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in acute and stable coronary syndromes.

Main Methods:

  • Review of evidence-based, interdisciplinary protocols for CAD management.
  • Discussion of criteria for heart team consultation in complex cases (e.g., SYNTAX score > 32).
  • Analysis of treatment pathways for acute coronary syndromes (ACS) and stable CAD, including PCI and CABG.

Main Results:

  • The heart team facilitates balanced, multidisciplinary decision-making for CAD patients.
  • Ad hoc percutaneous coronary intervention (PCI) is generally not recommended for complex cases; heart team discussion is advised first.
  • Culprit lesion PCI is often the initial choice for acute coronary syndrome (ACS); CABG is considered if complete PCI is not feasible.

Conclusions:

  • Multidisciplinary heart team review is essential for complex CAD, high-risk patients, and when complete revascularization is challenging.
  • Treatment decisions for acute coronary syndromes, whether stable or unstable, should be individualized, considering symptoms, stability, anatomy, and ischemia.
  • The choice between PCI and CABG requires careful consideration by the heart team, especially in complex anatomies or when complete PCI is not achievable.

Keywords:
Acute coronary syndromeCoronary artery bypass graftCoronary artery diseaseHeart teamPercutaneous coronary intervention

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