Heart Team Discussion of Patients with Severe Coronary Artery Disease in the United Kingdom following Joint ESC / EACTS Guidelines on Myocardial Revascularization – A Multi-Centre Study

• Published in: The Journal of thoracic and cardiovascular surgery
• Main Authors: Yates, Martin T., MRCS, Balmforth, Damian, MRCS, Soppa, Gopal KR., MRCS, Uppal, Rakesh, FRCS(CTh), Desai, Jatin, FRCS(CTh), Jahangiri, Marjan, FRCS(CTh)
• Format: Journal Article
• Language: English
• Published: 2014
• Subjects: Cardiothoracic Surgery
• ISSN: 0022-5223
• DOI: 10.1016/j.jtcvs.2014.10.110

Abstract Objective Joint European Society of Cardiology and European Association for Cardiothoracic Surgery (ESC/EACTS) Guidelines on Myocardial Revascularisation advocate Heart Team discussion of all patients with severe coronary artery disease. We have previously shown low rates of compliance in a single centre study carried out six months after publication of the guidelines. We now assess the impact of the guidelines on referral patterns to the Heart Team at three major cardiothoracic centres in the United Kingdom following a further year of publicity. Methods Joint guidelines were published in August 2010. All patients with severe disease undergoing percutaneous coronary intervention at four institutions in the United Kingdom were identified six months before (Jan-June 2010) and eighteen months after (Jan-June 2012) their introduction. Heart Team discussion was determined from minutes of multidisciplinary meeting. Results In 2010, 621 patients underwent elective PCI before the guidelines, of which 224 had surgical disease. Of these, only 37 (17%) were discussed by the Heart Team prior to intervention. Furthermore, 31 patients had three vessel coronary disease and were not discussed. In 2012, following introduction of the guidelines, 686 elective PCI were performed, of which 275 had surgical disease. Again only 47 (17%) were discussed by the Heart Team prior to intervention (p = NS). Similarly, 27 had three vessel disease and were discussed. Conclusion Despite joint ESC/EACTS guidelines and attention given to this subject by the professional bodies, a significant number of patients with severe coronary artery disease who would clearly benefit from surgical revascularization are not being discussed by the Heart Team and receiving optimal treatment.