Prognostic impact of implementation of heart team approach on cardiovascular outcomes in patients with complex coronary artery disease

Keywords: coronary artery disease, heart team approach, outcome

Results: We found that implementation of the quality improvement program would result in a significant improvement in the activation of HTA (before: 26.4%; during: 68.6%, after 61.7%, P <0.001) and a significant increase in the final choice of CABG (before: 11.1%; during: 16.8%, after 20.4%, P = 0.006). There were 448 patients (59.6%) undergoing HTA in total. Some baseline characteristics were significantly different between HTA and non-HTA groups, including younger age and a lower level of EuroSCORE II, a higher prevalence of three-vessel disease and cigarette smoking, and a lower prevalence of history of PCI or CABG in the HTA group. Among treatment strategies, CABG was recommended more in the HTA group than in the non-HTA group (75.5% vs. 37.2%, P <0.001); however, patients/family usually chose PCI finally either in the HTA (62.7%) or non-HTA group (82.6%). Nevertheless, more patients/family still chose CABG as the treatment strategy in the HTA group than in the non-HTA group. (26.8% vs. 7.2%, P <0.001). During mean 487.14 ± 377.69 days follow-up, the primary composite endpoint was achieved in 213 patients. HTA was associated with a lower risk of primary composite endpoint, total death, myocardial infarction, or unplanned coronary revascularization (18.1% vs. 42.4%, P <0.001; 10.9% vs. 21.7%, P <0.001; 3.8% vs. 9.2%, P = 0.002; 8.7% vs. 22.7%, P <0.001, respectively). By using multi-variate analysis, some independent predictors of the primary composite endpoint were identified, including HTA (odds ratio 0.514, 95% confidence interval 0.375-0.704, P <0.001).