The modified heart team protocol facilitated the revascularization decision-making quality in complex coronary artery disease
Authors: Ma Hanping , Lin Shen , Li Xi , Wang Yang , Yang Weixian , Dou Kefei , Liu Sheng , Zheng Zhe ,   Modified Heart Team Protocol Study Group, Ling Yunpeng , Zhang Lufeng , Liu Jian , Chen Yu , Liu Chuanfen , Ma Yuliang , Liu Gang , Gao Chuanyu , Cheng Zhaoyun , Shao Fang , Sun Yuxiao , Wang Xianpei , Qi Datun , An Songtao , Hu Junlong , Zhao Ziniu , Dou Kefei , Wu Yuan , Liu Rong , Song Weihua , Zhang Jun , Zhao Jie , Yang Weixian , Yin Dong , Song Lei , Zhao Hanjun , Hu Fenghuan , Gao Lijian , Qian Jie , Cui Bin , Yang Yan , Luo Xinjin , Gao Ge , Wang Liqing , Cui Jingang , Wang Xianqiang , Hu Xiaopeng , Liu Sheng , Zheng Zhe , Wei Lai , Lin Yi , Sun Xiaoning , Xia Limin , Yang Junqing , Xie Nianjin , Dong Haojian , Li Yue , Gong Yongtai , Sheng Li , Yu Bo , Yang Shuang , Xing Lei , Yang Guang , Chen Tao , Ma Qianli , Chen Lihua , Pan Hongwei , Cheng Xiang , Dong Nianguo , Li Ming , Li Fei , Liu Juanwei , He Yuquan , Bai Ming , Zhu Youqi , Chen Xin , Huang Fuhua , Qiu Zhibing , Pu Jun , Zhang Qing , Jin Shuxuan , Du Yongping , Han Lin , Tang Yangfeng , Zhang Guanxin , Song Xiantao , Dong Ran , Tu Chenchen , Zhang Dongfeng , Zhang Mingduo , Zhang Min , Zhao Yang , Zheng Jubing , Song Yue , Li Yang , He Yong , Liu Zhigang , Lu Wanli , Zhang Jianliang , Wang Zhengqing , Wang Lianqun , Yang Dongyan , Li Junshan , Jin Zening , Meng Shuai , Jia Ruofei , Zhang Qi , You Jieyun , Luo Yu , Tao Liang , Feng Xueguo , Yu Huadong , Li Yan , Guo Wangang , Zhang Dongwei , Xue Yusheng , Jiang Jun , Wang Huishan , Liu Tao , Xu Shu , Yang Zhonglu 
Published: February 2025

Abstract

OBJECTIVES
A lack of standardization in heart team implementation potentially leads to suboptimal decision-making quality, and we previously established a modified heart team protocol to improve the decision-making quality. The present trial was to validate the effect of the modified heart team implementation protocol on improving the decision-making quality versus the conventional protocol in complex coronary artery disease (CAD).

METHODS
Eligible interventional cardiologists, cardiac surgeons and non-interventional cardiologists were randomly allocated to the intervention or control arm and established 12 heart teams in each arm. The 12 heart teams in each arm were randomly divided into 6 pairs, and 480 historic cases with complex CAD into 6 sets of 80 cases. In each arm, each set of 80 cases was discussed independently by one pair of heart teams, with each case finally receiving two heart team decisions (‘pairwise decisions’). The intervention arm conducted heart team decision-making according to the previously established protocol and the control arm based on guideline recommendations. The primary outcome was the overall percent agreement of the inter-team pairwise decisions. Decision-making appropriateness was further analysed.

RESULTS
A total of 36 cardiac surgeons, 36 interventional cardiologists and 12 non-interventional cardiologists from 26 centres were enrolled. The overall percent agreement was significantly higher in the intervention arm than the control arm (72.1% vs 65.8%, P = 0.04; kappa 0.51 vs 0.37). Both team-level (19.4% vs 33.0%; P &lt; 0.001) and specialist-level (interventional cardiologists, 19.8% vs 37.7%, P &lt; 0.001; cardiac surgeons, 19.8% vs 28.7%, P &lt; 0.001) inappropriateness rate of decision-making was significantly lower in the intervention arm than the control arm.

CONCLUSIONS
The modified heart team implementation protocol improved the decision-making quality and appropriateness compared with the guideline-based protocol.