The Heart Team Approach to Coronary Revascularization—Have We Crossed the Lines of Evidence-Based Medicine?

Evidence-based medicine demands considerable time and decision-making skills to navigate through the proliferating data. A hierarchical “pyramid of evidence” has been formulated to help categorize data quality. The hierarchical data are processed into recommendations in Practice Guideline statements...

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Bibliographic Details
Published in:The American journal of cardiology 2013-11, Vol.112 (9), p.1516-1519
Main Authors: Rosenschein, Uri, MD, Nagler, Rafael M., MD, Rofe, Amnon, MD
Format: Article
Language:English
Subjects:
American Heart Association
Bias
Cardiology - methods
Cardiovascular
Cardiovascular disease
Clinical medicine
Coronary Artery Disease - surgery
Coronary vessels
Decision Making
Evidence-based medicine
Evidence-Based Medicine - methods
Heart
Heart attacks
Humans
Medicine
Mortality
Myocardial Revascularization - standards
Patient Care Team
Patient Selection
Patients
Studies
United States
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Summary:Evidence-based medicine demands considerable time and decision-making skills to navigate through the proliferating data. A hierarchical “pyramid of evidence” has been formulated to help categorize data quality. The hierarchical data are processed into recommendations in Practice Guideline statements. Recently, both American College of Cardiology/American Heart Association/Society for Cardiac Angiography and Interventions and European Society of Cardiology guidelines for percutaneous coronary intervention embraced a new “heart team approach” as the preferred method to optimize revascularization decision making in cases of complex coronary anatomy. This extrapolation of a research method to the broad clinical practice has potential limitations. We suggest that both the need for a new method to optimize patient triage for the various revascularization strategies and the method to optimize decision making should be discussed. Published data suggest only minor deviations from guideline-based indications. Furthermore, traditional clinical judgment may result in a better patient outcome than arbitrary treatment assignment by rigid set of criteria. In conclusion, the need for a new decision-making process in the choice of revascularization strategy should be further explored and supported by scientific evidence.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.06.041