title: Implementation and consistency of Heart Team decision-making in complex coronary revascularisation.
abstract: BACKGROUND
  A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation.
  
  
  METHODS
  We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making.
  
  
  RESULTS
  The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced.
  
  
  CONCLUSIONS
  The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account.
authors.affiliation: Department of Cardiology, St. Thomas' Hospital, London, UK.
authors.forename: Antonis N
authors.initials: AN
authors.lastname: Pavlidis
authors.affiliation: Cardiovascular Division, St. Thomas' Hospital Campus, King's College, London, UK.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Department of Cardiology, St. Thomas' Hospital, London, UK; Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK. Electronic address: grigoris.karamasis@gmail.com.
authors.forename: Grigoris V
authors.initials: GV
authors.lastname: Karamasis
authors.affiliation: Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
authors.affiliation: Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Young
authors.affiliation: Department of Cardiology, St. Thomas' Hospital, London, UK.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Clapp
authors.affiliation: Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Blauth
authors.affiliation: Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Roxburgh
authors.affiliation: Department of Cardiology, St. Thomas' Hospital, London, UK.
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Thomas
authors.affiliation: Cardiovascular Division, St. Thomas' Hospital Campus, King's College, London, UK.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Redwood
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D010348:Patient Care Team; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Acute coronary syndromes; Chronic coronary disease; Coronary angioplasty; Coronary artery bypass grafting