title: The heart team approach to coronary revascularization--have we crossed the lines of evidence-based medicine?
abstract: Evidence-based medicine demands considerable time and decision-making skills to navigate through the proliferating data. A hierarchical "pyramid of evidence" has been formulated to help categorize data quality. The hierarchical data are processed into recommendations in Practice Guideline statements. Recently, both American College of Cardiology/American Heart Association/Society for Cardiac Angiography and Interventions and European Society of Cardiology guidelines for percutaneous coronary intervention embraced a new "heart team approach" as the preferred method to optimize revascularization decision making in cases of complex coronary anatomy. This extrapolation of a research method to the broad clinical practice has potential limitations. We suggest that both the need for a new method to optimize patient triage for the various revascularization strategies and the method to optimize decision making should be discussed. Published data suggest only minor deviations from guideline-based indications. Furthermore, traditional clinical judgment may result in a better patient outcome than arbitrary treatment assignment by rigid set of criteria. In conclusion, the need for a new decision-making process in the choice of revascularization strategy should be further explored and supported by scientific evidence.
authors.affiliation: Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Rosenschein
authors.forename: Rafael M
authors.initials: RM
authors.lastname: Nagler
authors.forename: Amnon
authors.initials: A
authors.lastname: Rofe
mesh_terms: D000572:American Heart Association; D002309:Cardiology / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D009204:Myocardial Revascularization / Q000592:standards*; D010348:Patient Care Team; D018579:Patient Selection; D014481:United States