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Comparison of patients with multivessel disease treated at centers with and without on-site cardiac surgery

Eilon Ram1, Ilan Goldenberg2, Yigal Kassif1

  • 1Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

The Journal of Thoracic and Cardiovascular Surgery
|February 18, 2018
PubMed

Insights

Stand-alone interventional cardiology units without cardiac surgery services and a heart team are linked to more percutaneous coronary intervention (PCI) referrals. A heart team approach is crucial for appropriate multivessel coronary artery disease treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Consolidation of cardiac surgery services (CSS) has led to more stand-alone interventional cardiology units.
  • These units often manage patients with multivessel coronary artery disease (CAD) requiring revascularization.

Purpose of the Study:

  • To evaluate the impact of a heart team on decision-making and outcomes for multivessel CAD patients in stand-alone interventional cardiology units.
  • To assess the influence of on-site CSS availability on treatment choices (PCI vs. CABG).

Main Methods:

  • Prospective study of 1063 consecutive patients with multivessel disease across 22 Israeli hospitals (Jan-Apr 2013).
  • Hospitals were categorized based on the presence or absence of on-site CSS.
  • Multivariate logistic regression analyzed factors influencing PCI vs. CABG referral.

Main Results:

  • 54% of patients underwent PCI, 46% underwent CABG.
  • Hospitals without on-site CSS performed PCI in 65% of cases vs. 46% in hospitals with CSS (P < .001).
  • Absence of on-site CSS and a heart team independently increased PCI referral likelihood by 2.5-fold (OR, 2.54).

Conclusions:

  • Patients with multivessel CAD treated in centers without on-site CSS receive fewer guideline-based CABG interventions.
  • A heart team approach is recommended for all centers, including stand-alone interventional cardiology units, to ensure optimal patient care.
Abstract

Keywords:
adultcoronary artery bypass graftscoronary stentspercutaneous coronary intervention

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