Coronary artery disease: when to withhold a decision and call in the Heart Team? Almost never

Abstract

The expansion of the options for the treatment of patients with stable multivessel coronary artery disease (CAD), including medical therapy or myocardial revascularization by a surgical or a percutaneous strategy, has raised the need to set the decision-making process to select the optimal therapy on a multidisciplinary approach. Indeed, this latter would potentially lead to identify the most appropriate strategy for a given patient in the most transparent, shared and comprehensive way as possible. The multidisciplinary approach has been widely encouraged in the cardiovascular field, where it has been defined as "Heart Team" (HT), a collegial system essentially including a cardiac surgeon, a clinical cardiologist and an interventionalist. However, due to the unavailability of on-site surgery in many centers, along with the increasing use of sophisticated materials and advanced technologies, the growing confidence of interventionalists with more meticulous and complex techniques, in addition to sharper guideline indications, the HT approach may currently lead to an anachronistic and unjustified slowdown of the decision-making process, sometimes until impasse, with subsequent increase in social and health costs. Therefore, the present article will examine the possibilities to judiciously restrict the actual HT use for choosing the treatment of patients with stable multivessel CAD at higher complexity.