Feasibility and Effectiveness of a Real-time Heart Team Approach in Complex CAD

This study is aimed to evaluate the clinical outcomes, efficiency and feasibility of the real-time heart team approach and the conventional heart team approach.

This study is a multicenter, randomized controlled trial. According to the inclusion and exclusion criteria, patients with complex coronary artery disease undergoing elective coronary angiography will be prospectively enrolled in the study. Patients will be randomly assigned to the real-time heart team group and the conventional heart team group by block randomization. The real-time heart team group needs to conduct multidisciplinary heart team discussion during the coronary angiography process, while the traditional heart team group needs to conduct multidisciplinary heart team discussion offline and face-to-face after the coronary angiography process. Patients who are not randomized will be registered. This study will prospectively collect the patient information, heart team meeting process, clinical treatment, and clinical outcomes to evaluate the efficiency and feasibility and differences in clinical outcomes of patients under different heart team approaches.

Patients randomized to this group will be accessed and discussed by multidisciplinary specialists during the coronary angiography process

Patients randomized to this group will be accessed and discussed offline and face-to-face by multidisciplinary specialists after the coronary angiography process

When the patient is eligible for the study, the interventional cardiologist will invite a cardiac surgeon to conduct a heart team discussion. Both specialists will assess the patient comprehensively and make an optimal decision for the patient, with consideration patient's preference.

a composite of all-cause death, myocardial infarction, stroke, repeated revascularization, ischemic symptoms with hospital admission.

assessment of the heart team dicision appropriateness according to Appropriateness Use Criteria and guidelines

assessment of the heart team dicision distribution, such as the rate of CABG, PCI, and medical treatment

to assess the time consuming of heart team organization and discussion during or after the coronary angiography

to assess the time consuming of the angiography to heart team meeting time and heart team meeting to final treatment time

including all-cause death, cardiac death, myocardial infarction, stroke, revascularization of target vessels or transplanted vessels, revascularization for any reason, be admitted to hospital with angina again, readmission for cardiac reasons and readmission for any reason

Inclusion Criteria: Significant stenosis in the left main or left main equivalent with or without stenosis in one of the other vessels[Significant stenosis is defined as: 1) a diameter stenosis of at least 50% reduction in luminal diameter by visual assessment or 2) any total occlusion (no age limitation and no exclusion of unfavorable anatomic features); Left main equivalent disease is defined as significant stenosis of the ostium of the left anterior descending and the ostium of the left circumflex.] At least 1 significant stenosis in all 3 major epicardial territories supplying viable myocardium; Other conditions that the interventional cardiologist considers necessary to discuss with cardiac surgeons due to technical and risk considerations. Exclusion Criteria: Less than 18 years of age; Previous history of PCI or CABG; Admitted for AMI, ECG and biomarker detection indicated acute stage; Patients with severe heart valvular disease, major vascular disease, and giant ventricular aneurysm require surgical treatment; Combined with AF or severe arrhythmia; Other patients admitted to hospital due to emergency circumstances who are not suitable to wait for elective revascularization; Rejection or exclusion of a revascularization mode (PCI or CABG); Refuse to participate in the study.