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The Impact of a Dedicated Chronic Total Occlusion PCI Program on Heart Team Decision Making. | LitMetric

AI Article Synopsis

  • A heart team (HT) approach is recommended for making decisions on treating patients with complex coronary artery disease (CAD), reflecting a shift in practice over the past decade as more high-risk patients are now being considered for intervention.
  • An observational study at St Thomas' Hospital analyzed 375 cases discussed in HT meetings, finding that many patients were male with multivessel CAD and a significant proportion had chronic total occlusions (CTOs).
  • The findings suggested that a dedicated program for complex coronary interventions led to a notable change in treatment recommendations, with a majority of historically unsatisfactory cases now more likely to receive revascularization referrals instead of just medical management.

Article Abstract

Background: Guidelines endorse a heart team (HT) approach to standardize the decision-making process for patients with complex coronary artery disease (CAD). With percutaneous treatment options for complex CAD increasing, we hypothesized that practice had changed over the past decade-and that more individuals, previously deemed too high risk for intervention, would now be referred for either surgical or percutaneous revascularization.

Methods: This observational study was conducted at St Thomas' Hospital (London, United Kingdom). All patients discussed at HT meetings were recorded and treatment recommendations audited. A subset of historic cases was selected for blinded, repeat discussion.

Results: From April 2018 to 2019, a total of 52 HT meetings discussing 375 cases were held. Patients tended to be male, with a majority demonstrating multivessel CAD in the context of preserved left ventricular function. SYNTAX scores were balanced across the tertiles. Thirty-five percent of patients had at least 1 chronic total occlusion (mean J-CTO, 3 [interquartile range, 2-3]), affecting the right coronary artery in 60%. Fifteen historic patients with isolated CTOs were re-presented an average of 8 years later; only 3 patients received the same outcome, with 80% now receiving a recommendation for revascularization over medical therapy.

Conclusions: A dedicated program supporting complex coronary intervention is associated with a change in treatment recommendations issued by the local HT. In line with international guidelines, this might indicate that any complex or multivessel CAD should be discussed at HT meetings with, ideally, the presence of CTO operators.

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Source
http://dx.doi.org/10.25270/jic/21.00447DOI Listing

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