Key result
In patients with severe coronary artery disease, multidisciplinary Heart Team-guided revascularization with CABG or PCI was associated with significantly lower rates of MACCE compared to optimal medical therapy alone (30.9% and 44.5% vs 61.4%, respectively).
Why the study?
The study was conducted to investigate the outcomes of patients with severe CAD after implementing various treatment strategies following multidisciplinary Heart Team discussion.
Does the choice of treatment strategy (OMT alone, OMT+CABG, or OMT+PCI) following a multidisciplinary Heart Team discussion affect the rate of MACCE in patients with severe coronary artery disease?
Observational (n=1,286)
No
Does the choice of treatment strategy (OMT alone, OMT+CABG, or OMT+PCI) following a multidisciplinary Heart Team discussion affect the rate of MACCE in patients with severe coronary artery disease?
p-value: p=<0.05
In real-world patients with severe CAD, implementation of multidisciplinary Heart Team decisions showed that CABG was associated with the lowest rate of MACCE compared to PCI and OMT alone, though OMT patients were significantly older and more frail.
Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) follow-up of 37 (14) months of patients with severe CAD (three-vessel [3-VD] or/and left main [LM] disease) qualified after MHT discussion to optimal medical treatment (OMT) alone, OMT and coronary artery bypass grafting (CABG), or OMT and percutaneous coronary intervention (PCI) were evaluated. As the primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) (i.e., death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) were considered. Result: From 2016 to 2019, 176 MHT meetings were held, and a total of 1286 participants with severe CAD and completely implemented MHT decisions (OMT, CABG, or PCI for 251, 356, and 679 patients, respectively) were included. The occurrence of the primary endpoint was significantly increased in OMT-group (154 (61.4%) vs. CABG and PCI groups—110 (30.9%) and 302 (44.5%) patients, respectively (p < 0.05). For interventional strategies only—CABG was associated with reduced rates of MACCE and repeat revascularization, while the superiority of PCI for stroke and disabling stroke was observed (p < 0.05). The general health status assessed at the end of the follow-up was significantly better for patients who underwent CABG or PCI than in the OMT group (p < 0.05). Conclusions: In this real-life study, we presented a single-center experience of providing optimal medical care for patients with severe CAD following MHT discussion.
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Jonik et al. (2022) conducted an observational in Severe coronary artery disease (three-vessel or left main disease) (n=1,286). Coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) vs. Optimal medical therapy (OMT) alone was evaluated on Major adverse cardiac or cerebrovascular events (MACCE) (death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) (p=<0.05). In patients with severe coronary artery disease, multidisciplinary Heart Team-guided revascularization with CABG or PCI was associated with significantly lower rates of MACCE compared to optimal medical therapy alone (30.9% and 44.5% vs 61.4%, respectively).
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