4 years ago

Comparison of Patients with Multi-Vessel Disease Treated at Centers With and Without On-Site Cardiac Surgery

The regional needs and consolidation of cardiac surgery services result in an increased number of stand-alone interventional cardiology units. We aimed to explore the impact of a heart team on the decision making and outcomes of patients with multi-vessel coronary artery disease referred for coronary revascularization in stand-alone interventional cardiology units. Methods This prospective study included 1063 consecutive patients with multi-vessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention (PCI), with or without on-site cardiac surgery services. Results Of the 1063 patients, 487 (46%) underwent coronary artery bypass graft (CABG) and 576 (54%) PCI. A higher proportion of patients (65%) underwent PCI in hospitals without on-site cardiac surgery, compared to those with on-site services (46%; p<0.001). Furthermore, patients referred to CABG from hospitals without on-site cardiac surgery had a significantly higher mean SYNTAX score compared to those who underwent CABG in centers with on-site surgery services (29 vs. 26, respectively; p=0.018). Multivariate logistic regression analysis consistently showed that the absence of on-site cardiac surgery and a heart team was independently associated with a 2.5-fold increased likelihood for predicting the referral of PCI rather than CABG (OR=2.54 [95% CI 1.8 - 3.6]). Conclusions Patients with multi-vessel coronary artery disease treated in centers without on-site cardiac surgery services receive a lower rate of appropriate guideline-based intervention with CABG. These findings suggest that a heart-team approach should be mandatory even in centers with stand-alone interventional cardiology units.

Publisher URL: www.sciencedirect.com/science

DOI: S0022522317324777

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