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Heart Team/Guidelines Discordance Is Associated With Increased Mortality: Data From a National Survey of

Guy Witberg1,2, Amit Segev2,3, Yaron D Barac4,2

  • 1Department of Cardiology (G.W., H.V.-A., R.K.), Rabin Medical Center, Petach-Tikva, Israel.

Circulation. Cardiovascular Interventions
|January 11, 2021
PubMed

Insights

Guideline discordant revascularization for complex coronary artery disease is common and linked to higher mid-term mortality. This occurs more often in elderly patients and those treated at centers without cardiac surgery services.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Practice guidelines recommend the SYNTAX score (SS) for selecting revascularization strategies in complex coronary artery disease.
  • Data on implementing these guidelines and the outcomes of discordant revascularization are limited.

Purpose of the Study:

  • To evaluate the frequency and consequences of guideline-discordant revascularization in real-world complex coronary artery disease patients.
  • To identify predictors of guideline discordance and its impact on mid-term mortality.

Main Methods:

  • Retrospective analysis of a prospective national survey of consecutive patients with complex coronary artery disease.
  • SYNTAX score (SS) calculated by a CoreLab; patients categorized by heart team/guideline agreement or discordance.

Main Results:

  • 17.3% of 979 patients had guideline-discordant revascularization. Predictors included age, no cardiac surgery service, SS, and prior PCI/MI.
  • Thirty-day outcomes were similar, but 3-year mortality was significantly higher in discordant cases (17.6% vs. 8.4%).

Conclusions:

  • Guideline discordant revascularization is not infrequent in complex coronary artery disease.
  • Discordance is more likely in elderly patients, those with higher SS, and at centers without cardiac surgery.
  • Guideline discordant revascularization is associated with increased mid-term mortality.
Abstract

Keywords:
consensuscoronary artery bypasscoronary artery diseasemyocardial infarctionpercutaneous coronary interventions

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