Coronary disease & ACSRandomised controlled trial
Real-Time Heart Team for Revascularization in Complex Coronary Artery Disease
- Randomised controlled trial
- non-inferiority
- 3 cardiac centres
Authors' conclusion
Compared with the conventional heart team, the real-time heart team significantly improved care efficiency and process evaluation metrics, with similar clinical outcomes and decision making.
Study context
- Population
- Patients with de novo left main or 3-vessel coronary artery disease (CAD)
- Participants
- 490 patients
- Comparison
- Real-time heart team vs conventional heart team
- Real-timen = 245
- Conventionaln = 245reference
- Primary endpoint
- Implementation value (care efficiency: waiting time for treatment, recatheterization, specialist workload, economic outcomes; process evaluation metrics) and safety (1-year major adverse cardiovascular and cerebrovascular events (MACCE) and revascularization decision making)
Primary result
Care efficiency
Percentage of decrease
18.0%
P < 0.001
By group
Real-time
2 days [Q1-Q3: 0-7 days]
Waiting time for final therapy, median (Q1-Q3) · Recatheterization rate 12.5% · Specialist high workload rate 5.3%
Conventional
5 days [Q1-Q3: 2-10 days]
Waiting time for final therapy, median (Q1-Q3) · Recatheterization rate 98.9% · Specialist high workload rate 29.0%
As reported in the abstract
Further findings
Process evaluation metrics
Discussion time Real-time 4.0 ± 1.8 min · Conventional 3.4 ± 1.6 min
Chief surgeon participation
Multidisciplinary synchronous shared decision making
Process evaluation metrics
- Better specialist satisfaction (NASA Task Load Index) with real-time
Safety
| Outcome | Real-time | Conventional | risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| MACCE · 1 year · noninferior | 8.2% | 10.6% | −2.45% (−7.61%-2.71%) | P for non-inferiority < 0.001 | |
| −10−505Difference (linear scale) |
Revascularization decision (percutaneous coronary intervention (PCI), CABG, medical therapy)
- Proportions similar between groups
- P = 0.892
Original publication
Summarised from the published abstract; every number is checked against it