Table 1:
Open in new tab

Main characteristics of the studies focusing on CAD

StudyYearDesignNumber of patientsStudy periodArea of focusInterventionMain findings
Bonzel et al.2016Retrospective—single centre34081997–2001All-comers adult cardiac coronary and valvularSurgical versus transcatheter intervention versus OMT

  • The Heart Team approach facilitates effective clinical decisions in both ad hoc situations and planned meetings, leading to consistent clinical benefits.

  • Evidence shows low subsequent rates of CABG and PCI following initial PCI, without an increase in mortality rates.

  • The data’s applicability to a broad patient population underscores its universal relevance, with stable post-PCI event rates indicating a transition to stable coronary artery disease.

Domingues et al.2018Retrospective—single centre10002010–2012CADSurgical versus transcatheter intervention versus OMT

  • Over one-third of cases required the Heart Team to seek further diagnostic tests prior to finalizing treatment plans, with invasive cardiac imaging necessary in 29.2% of instances.

  • Treatment advice from the Heart Team typically aligned with established clinical guidelines.

  • The study affirmed the practicality of the Heart Team method, offering clear and accountable decision-making, with recommendations usually enacted promptly after patient referral.

Patterson et al.2019Single-centre; retrospective2452012–2013CADSurgical versus medical versus transcatheter

  • Three-year follow-up indicated no significant survival difference between CABG and PCI patients, highlighting effective Heart Team decision-making.

  • The study emphasizes the Heart Team’s crucial role in navigating complex CAD treatment choices.

  • The Heart Team’s method integrates evidence-based medicine with diverse clinical expertise, essential for decisions in cases with clinical uncertainty.

Abdulrahman et al.2019Single-centre, retrospective2092012–2015CADSurgical versus medical versus transcatheter

  • The study showed that the presence of senior department directors influenced Heart Team treatment decisions, favouring CABG when the surgical director was present and PCI with the cardiology director.

  • Persistent hierarchy-based biases in Heart Team recommendations over time suggest that team composition, not just clinical guidelines, affects treatment choices.

  • The results highlight the necessity for measures to reduce hierarchical biases to achieve more uniform, patient-focused care for multivessel CAD.

Young et al.2020Single-centre, retrospective1662015–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s multidisciplinary model effectively evaluates complex coronary cases, integrating surgical and anatomical assessments.

  • Utilizing a decision aid rooted in evidence-based management aids the Heart Team in guiding patient care.

  • Observed in-hospital and 30-day mortality rates were 3.9% and 4.8%, respectively, within this structured team approach.

Tsang et al.2020Single centre, retrospective2452017–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s treatment recommendations varied from the initial cardiologist’s in nearly a third of cases.

  • Agreement between the Heart Team and the initial cardiologist was moderate, with a Cohen κ of 0.478.

  • Discrepancies arose more often when considering PCI or medication over CABG.

  • Higher discordance correlated with greater disagreement between the Heart Team’s and the original cardiologist’s interventions.

StudyYearDesignNumber of patientsStudy periodArea of focusInterventionMain findings
Bonzel et al.2016Retrospective—single centre34081997–2001All-comers adult cardiac coronary and valvularSurgical versus transcatheter intervention versus OMT

  • The Heart Team approach facilitates effective clinical decisions in both ad hoc situations and planned meetings, leading to consistent clinical benefits.

  • Evidence shows low subsequent rates of CABG and PCI following initial PCI, without an increase in mortality rates.

  • The data’s applicability to a broad patient population underscores its universal relevance, with stable post-PCI event rates indicating a transition to stable coronary artery disease.

Domingues et al.2018Retrospective—single centre10002010–2012CADSurgical versus transcatheter intervention versus OMT

  • Over one-third of cases required the Heart Team to seek further diagnostic tests prior to finalizing treatment plans, with invasive cardiac imaging necessary in 29.2% of instances.

  • Treatment advice from the Heart Team typically aligned with established clinical guidelines.

  • The study affirmed the practicality of the Heart Team method, offering clear and accountable decision-making, with recommendations usually enacted promptly after patient referral.

Patterson et al.2019Single-centre; retrospective2452012–2013CADSurgical versus medical versus transcatheter

  • Three-year follow-up indicated no significant survival difference between CABG and PCI patients, highlighting effective Heart Team decision-making.

  • The study emphasizes the Heart Team’s crucial role in navigating complex CAD treatment choices.

  • The Heart Team’s method integrates evidence-based medicine with diverse clinical expertise, essential for decisions in cases with clinical uncertainty.

Abdulrahman et al.2019Single-centre, retrospective2092012–2015CADSurgical versus medical versus transcatheter

  • The study showed that the presence of senior department directors influenced Heart Team treatment decisions, favouring CABG when the surgical director was present and PCI with the cardiology director.

  • Persistent hierarchy-based biases in Heart Team recommendations over time suggest that team composition, not just clinical guidelines, affects treatment choices.

  • The results highlight the necessity for measures to reduce hierarchical biases to achieve more uniform, patient-focused care for multivessel CAD.

Young et al.2020Single-centre, retrospective1662015–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s multidisciplinary model effectively evaluates complex coronary cases, integrating surgical and anatomical assessments.

  • Utilizing a decision aid rooted in evidence-based management aids the Heart Team in guiding patient care.

  • Observed in-hospital and 30-day mortality rates were 3.9% and 4.8%, respectively, within this structured team approach.

Tsang et al.2020Single centre, retrospective2452017–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s treatment recommendations varied from the initial cardiologist’s in nearly a third of cases.

  • Agreement between the Heart Team and the initial cardiologist was moderate, with a Cohen κ of 0.478.

  • Discrepancies arose more often when considering PCI or medication over CABG.

  • Higher discordance correlated with greater disagreement between the Heart Team’s and the original cardiologist’s interventions.

CABG = coronary artery bypass grafting; CAD = coronary artery disease; OMT = optimal medical therapy; PCI = percutaneous coronary intervention.

Table 1:
Open in new tab

Main characteristics of the studies focusing on CAD

StudyYearDesignNumber of patientsStudy periodArea of focusInterventionMain findings
Bonzel et al.2016Retrospective—single centre34081997–2001All-comers adult cardiac coronary and valvularSurgical versus transcatheter intervention versus OMT

  • The Heart Team approach facilitates effective clinical decisions in both ad hoc situations and planned meetings, leading to consistent clinical benefits.

  • Evidence shows low subsequent rates of CABG and PCI following initial PCI, without an increase in mortality rates.

  • The data’s applicability to a broad patient population underscores its universal relevance, with stable post-PCI event rates indicating a transition to stable coronary artery disease.

Domingues et al.2018Retrospective—single centre10002010–2012CADSurgical versus transcatheter intervention versus OMT

  • Over one-third of cases required the Heart Team to seek further diagnostic tests prior to finalizing treatment plans, with invasive cardiac imaging necessary in 29.2% of instances.

  • Treatment advice from the Heart Team typically aligned with established clinical guidelines.

  • The study affirmed the practicality of the Heart Team method, offering clear and accountable decision-making, with recommendations usually enacted promptly after patient referral.

Patterson et al.2019Single-centre; retrospective2452012–2013CADSurgical versus medical versus transcatheter

  • Three-year follow-up indicated no significant survival difference between CABG and PCI patients, highlighting effective Heart Team decision-making.

  • The study emphasizes the Heart Team’s crucial role in navigating complex CAD treatment choices.

  • The Heart Team’s method integrates evidence-based medicine with diverse clinical expertise, essential for decisions in cases with clinical uncertainty.

Abdulrahman et al.2019Single-centre, retrospective2092012–2015CADSurgical versus medical versus transcatheter

  • The study showed that the presence of senior department directors influenced Heart Team treatment decisions, favouring CABG when the surgical director was present and PCI with the cardiology director.

  • Persistent hierarchy-based biases in Heart Team recommendations over time suggest that team composition, not just clinical guidelines, affects treatment choices.

  • The results highlight the necessity for measures to reduce hierarchical biases to achieve more uniform, patient-focused care for multivessel CAD.

Young et al.2020Single-centre, retrospective1662015–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s multidisciplinary model effectively evaluates complex coronary cases, integrating surgical and anatomical assessments.

  • Utilizing a decision aid rooted in evidence-based management aids the Heart Team in guiding patient care.

  • Observed in-hospital and 30-day mortality rates were 3.9% and 4.8%, respectively, within this structured team approach.

Tsang et al.2020Single centre, retrospective2452017–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s treatment recommendations varied from the initial cardiologist’s in nearly a third of cases.

  • Agreement between the Heart Team and the initial cardiologist was moderate, with a Cohen κ of 0.478.

  • Discrepancies arose more often when considering PCI or medication over CABG.

  • Higher discordance correlated with greater disagreement between the Heart Team’s and the original cardiologist’s interventions.

StudyYearDesignNumber of patientsStudy periodArea of focusInterventionMain findings
Bonzel et al.2016Retrospective—single centre34081997–2001All-comers adult cardiac coronary and valvularSurgical versus transcatheter intervention versus OMT

  • The Heart Team approach facilitates effective clinical decisions in both ad hoc situations and planned meetings, leading to consistent clinical benefits.

  • Evidence shows low subsequent rates of CABG and PCI following initial PCI, without an increase in mortality rates.

  • The data’s applicability to a broad patient population underscores its universal relevance, with stable post-PCI event rates indicating a transition to stable coronary artery disease.

Domingues et al.2018Retrospective—single centre10002010–2012CADSurgical versus transcatheter intervention versus OMT

  • Over one-third of cases required the Heart Team to seek further diagnostic tests prior to finalizing treatment plans, with invasive cardiac imaging necessary in 29.2% of instances.

  • Treatment advice from the Heart Team typically aligned with established clinical guidelines.

  • The study affirmed the practicality of the Heart Team method, offering clear and accountable decision-making, with recommendations usually enacted promptly after patient referral.

Patterson et al.2019Single-centre; retrospective2452012–2013CADSurgical versus medical versus transcatheter

  • Three-year follow-up indicated no significant survival difference between CABG and PCI patients, highlighting effective Heart Team decision-making.

  • The study emphasizes the Heart Team’s crucial role in navigating complex CAD treatment choices.

  • The Heart Team’s method integrates evidence-based medicine with diverse clinical expertise, essential for decisions in cases with clinical uncertainty.

Abdulrahman et al.2019Single-centre, retrospective2092012–2015CADSurgical versus medical versus transcatheter

  • The study showed that the presence of senior department directors influenced Heart Team treatment decisions, favouring CABG when the surgical director was present and PCI with the cardiology director.

  • Persistent hierarchy-based biases in Heart Team recommendations over time suggest that team composition, not just clinical guidelines, affects treatment choices.

  • The results highlight the necessity for measures to reduce hierarchical biases to achieve more uniform, patient-focused care for multivessel CAD.

Young et al.2020Single-centre, retrospective1662015–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s multidisciplinary model effectively evaluates complex coronary cases, integrating surgical and anatomical assessments.

  • Utilizing a decision aid rooted in evidence-based management aids the Heart Team in guiding patient care.

  • Observed in-hospital and 30-day mortality rates were 3.9% and 4.8%, respectively, within this structured team approach.

Tsang et al.2020Single centre, retrospective2452017–2018CADSurgical versus medical versus transcatheter

  • The Heart Team’s treatment recommendations varied from the initial cardiologist’s in nearly a third of cases.

  • Agreement between the Heart Team and the initial cardiologist was moderate, with a Cohen κ of 0.478.

  • Discrepancies arose more often when considering PCI or medication over CABG.

  • Higher discordance correlated with greater disagreement between the Heart Team’s and the original cardiologist’s interventions.

CABG = coronary artery bypass grafting; CAD = coronary artery disease; OMT = optimal medical therapy; PCI = percutaneous coronary intervention.

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