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Published on: February 18, 2020
Enhanced outcomes for coronary artery disease obtained by a multidisciplinary heart team approach
Manabu Yamasaki1, Kohei Abe2, Rihito Horikoshi2
1Department of Cardiovascular Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuoku, Tokyo, 104-8560, Japan. manayama@luke.ac.jp.
Insights
Implementing a multidisciplinary heart team (MHT) approach for coronary artery disease (CAD) significantly reduced major adverse cardiovascular and cerebrovascular events (MACCE). This dedicated MHT strategy demonstrates clear benefits for CAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Coronary artery disease (CAD) management requires coordinated care.
- A multidisciplinary heart team (MHT) approach was implemented in 2012.
- Outcomes were compared between patients treated before and after MHT implementation.
Purpose of the Study:
- To assess the effectiveness of the MHT approach in patients with CAD.
- To compare major adverse cardiovascular and cerebrovascular events (MACCE) rates before and after MHT implementation.
Main Methods:
- Retrospective analysis of patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- Group NH (2009-2011) treated without MHT vs. Group H (2012-2014) treated with MHT.
- Primary outcome: MACCE (all-cause death, MI, stroke, readmission, TVR/revascularization).
Main Results:
- Significantly lower MACCE rates in Group H (21.1%) compared to Group NH (28.1%) at 3 years (P=.001).
- MHT approach (HR 0.737) and ejection fraction were associated with reduced MACCE.
- Higher SYNTAX score and EuroSCORE II were associated with increased MACCE.
Conclusions:
- The MHT approach effectively reduces MACCE in CAD patients.
- A dedicated MHT strategy offers significant benefits for managing coronary artery disease.
Background:
We implemented our multidisciplinary heart team (MHT) approach since 2012 for patients with coronary artery disease (CAD) and assessed the effectiveness of it by comparing outcomes in patients treated before and after the introduction of the MHT approach.
Methods:
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for CAD were performed in 802 and 57 patients from 2009 to 2011 in Group NH, and were performed in 867 and 160 patients from 2012 to 2014 in Group H, respectively. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke, cardiac-related readmission and target vessel repeat revascularisation (TVR) for PCI or revascularisation on grafted vessels for CABG.
Results:
MACCE occurred significantly more often in Group NH than in Group H at 3 years postoperatively (28.1% vs 21.1%) (log rank P = 0.001). Cox regression analysis showed that the MHT approach [hazard ratio (HR), 0.737; 95% confidence interval (CI), 0.60-0.91; P = 0.004] and ejection fraction (HR 0.976; 95% CI, 0.97-0.98; P < 0.0001) were associated with significantly lower rates of MACCE events, while SYNTAX score (HR 1.023; 95% CI 1.00-1.03, P < 0.0001) and EuroSCORE II (HR 1.014, 95% CI 0.60-0.91, P = 0.004) were associated with a higher rate of MACCE events.
Conclusion:
Our MHT approach was able to reduce the MACCE events of treatment for CAD. The dedicated MHT approach might be beneficial for patients with CAD.
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