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Title: Effect of ESC/EACTS guidelines on myocardial revascularisation on heart team discussion of patients with severe coronary artery disease in the United Kingdom
Author: Yates , Martin T.
ISNI:       0000 0004 5372 1717
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2015
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Joint European Society of Cardiology and European Association for Cardiothoracic Surgery (ESC/EACTS) Guidelines on Myocardial Revascularisation advocate Heart Team discussion of all patients with severe coronary artery disease. Furthermore, incomplete revascularisation is known to increase morbidity and mortality following intervention. The guidelines suggest that patients with left main stem, proximal LAD or three vessel disease (3VD) should be discussed with a surgeon prior to percutaneous coronary intervention (PCI). The aim of this project is to assess the impact of the guidelines on referral patterns to the Heart Team and myocardial revascularisation outcomes in the United Kingdom. Methods All patients undergoing revascularisation at three major cardiothoracic centres in London were studied. Patients undergoing PCI were identified from the British Cardiovascular Intervention Society Database. Data was collected prospectively from January to June 2010, prior to the guidelines and January to June 2012 following its publication. Heart team discussion or direct referral for surgery, for all patients with surgical disease, was determined from database and electronic patient records. Primary outcomes were Heart Team discussion and method of revascularisation. Results In 2010, 621 patients underwent elective PCI before the guidelines, of which 224 had potentially surgical disease. Of these, only 37 (15%) were discussed by the Heart Team prior to intervention. Furthermore, 41 (18%) of patients had three vessel coronary disease and only 10 (25%) of these were discussed. In 2012, following introduction of the guidelines, 686 elective PCI were performed, of which 272 had surgical disease. Again only 47 (17%) were discussed by the Heart Team prior to intervention (p = NS). Similarly, 43 (16%) had three vessel disease and only 16 (37%) were discussed. Of those patients undergoing elective PCl for severe coronary disease in 2010, only 98 (44%) were fully revascularised. In 2012, 133 (48%) received complete revascularisation. However, of those with 3VD, in 2010 only 7 (17%) were fully revascularised. Similarly, in 2012 only 4 (11 %) received full revascularisation. Conclusion Despite joint ESC/EACTS guidelines and attention given to this subject by the professional bodies, a significant number of patients with severe coronary artery disease who would clearly benefit from surgical revascularization are not being discussed by the Heart Team and receiving optimal treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available