The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease

Eur Heart J. 2013 Aug;34(32):2510-8. doi: 10.1093/eurheartj/eht059. Epub 2013 Feb 20.


Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.

Keywords: Appropriateness; Coronary artery bypass grafting; Guidelines; Heart Team; Multidisciplinary; Percutaneous coronary intervention; Revascularization; Shared decision-making; Underuse.

Publication types

  • Review

MeSH terms

  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Disease / therapy*
  • Decision Making*
  • Humans
  • Myocardial Revascularization / statistics & numerical data
  • Observer Variation
  • Patient Care Team / organization & administration*
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Practice Patterns, Physicians'*
  • Unnecessary Procedures