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. 2025 Jun 20;38(5):589-597.
doi: 10.1080/08998280.2025.2516981. eCollection 2025.

Long-term survival after multidisciplinary heart team-guided management of complex coronary artery disease

Taylor Pickering  1 , Austin Kluis  1   2 , Emily Shih  1   2 , John J Squiers  1   2 , Kyle McCullough  1 , Cody Dorton  1 , David O Moore  2 , Srinivasa P Potluri  3 , Molly Szerlip  3 , Karim Al-Azizi  3 , Ghadi Moubarak  1 , Jonathan Ladner  1 , Radhika Vaishnav  1 , Shelby McCoy  1 , Julius Ejiofor  2 , Rahul Sawhney  3 , Sarah Hale  1 , Justin M Schaffer  2 , Jasjit Banwait  1 , Katherine B Harrington  2 , William T Brinkman  2 , Lee R Hafen  2 , Robert L Smith  2 , Timothy J George  2 , J Michael DiMaio  1   2   4 , William H Ryan  2 , Kelley A Hutcheson  2
Affiliations

Long-term survival after multidisciplinary heart team-guided management of complex coronary artery disease

Taylor Pickering et al. Proc (Bayl Univ Med Cent). .

Abstract

Objective: Guidelines recommend a multidisciplinary heart team approach for managing complex coronary artery disease (CAD), yet its impact on clinical outcomes and adherence to recommendations is rarely reported.

Methods: Between June 2021 and August 2022, 210 high-risk patients with isolated, complex CAD were evaluated at our institution's weekly heart team conference for consideration of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), hybrid PCI/CABG, or optimal medical therapy (OMT). Adherence to recommendations and clinical outcomes, including 30-day, 1-year, and 2-year mortality, were assessed.

Results: Overall adherence to heart team recommendations was 92%, with 96% adherence for CABG, 90% for PCI, 87% for OMT, and 75% for hybrid PCI/CABG. CABG was the most frequently recommended treatment (53%) and demonstrated the lowest mortality at 1 year (4%) and 2 years (6%) compared with PCI (1 year, 28%; 2 year, 40%) and OMT (1 year, 10%; 2 year, 20%). CABG patients had a lower-than-expected mortality (observed-to-expected ratio 0.9), while PCI was associated with significantly higher mortality (observed-to-expected ratio 3.0).

Conclusion: This single-center multidisciplinary heart team approach for complex CAD offers a collaborative, patient-centered model that facilitates high adherence rates and favorable patient outcomes. These findings highlight the potential benefits of integrating multidisciplinary evaluation and support its implementation into standard practice for high-risk CAD patients.

Keywords: Coronary artery bypass grafting; coronary artery disease; long-term outcomes; multidisciplinary heart team; percutaneous coronary intervention.

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Conflict of interest statement

Dr. Potluri: Advisory board member, proctor, and speaker for Medtronic, Boston Scientific, Abbott, and Cordis; proctor and speaker for Edwards Lifesciences, Terumo, and AstraZeneca. Dr. Szerlip: Proctor, speaker, and consultant for Edwards Lifesciences; advisory board member, consultant, and proctor for Abbott Vascular; steering committee member for Medtronic; speaker for Boston Scientific. Dr. Al-Azizi: Proctor and consultant for Edwards Lifesciences; consultant and advisory board member for Medtronic; consultant for Boston Scientific; speaker bureau member. Dr. Harrington: Consultant for Abbott Laboratories and Maquet Cardiovascular; speaker for Artivion, Inc. and Medtronic, Inc.; speaker and advisory board member for Boston Scientific Corporation; speaker and proctor for Edwards Lifesciences Corporation. Dr. Brinkman: Teaching and travel support from Artivion; consultant for Bolton Medical, Inc., Maquet Cardiovascular, Medtronic, Terumo Medical Corporation, and W.L. Gore; advisory board member for Medtronic. Dr. Smith: Grant support recipient from Edwards Lifesciences; speaker honoraria recipient from Edwards Lifesciences, Abbott, and CryoLife. Dr. George: Speaker for Abiomed. Dr. DiMaio: Investment and ownership interests in HeartFlow, Inc. and Spectral MD. The remaining authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
Central Illustration. MHT recommendations, patient crossovers, and outcomes. Of 210 patients evaluated, recommendations were made for coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), optimal medical therapy (OMT), or hybrid procedures. Dashed lines indicate patient crossover between treatment groups. Outcomes for each group, including 30-day and 1-year mortality rates, adherence to recommendations, and observed-to-expected mortality ratios, are shown based on the actual treatments received.
Figure 2.
Figure 2.
Kaplan-Meier survival analysis for the coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and optimal medical therapy (OMT) cohorts.
See this image and copyright information in PMC

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