Temporal trends and clinical predictors of Heart Team consultation after coronary angiography: a nationwide registry-based analysis
K Gladys, K Malinowski, Z SiudakAbstract
Background
Over the past decade, the role of the Heart Team has strengthened, evolving from general recommendations based on expert consensus to current guidelines that formally endorse its use in complex revascularization decisions. Multidisciplinary Heart Team consultation is now recommended for selected patients undergoing coronary angiography, particularly those with complex coronary anatomy or multiple clinical comorbidities that affect procedural risk and long-term outcomes. However, despite formal recognition, real-world data on temporal trends and determinants of Heart Team referral remain limited.
Purpose
To evaluate temporal trends in Heart Team consultation rates after coronary angiography and to identify clinical, angiographic, and procedural predictors of referral.
Methods
Data from the Polish Registry of Invasive Cardiology Procedures (ORPKI) from the years 2014-2024 were extracted and analyzed.
Results
A total of 1 898 420 consecutive coronary angiographies were included. Temporal trends in Heart Team consultation varied by clinical presentation, but showed a general upward trend (p<0.001). Referral rates remained stable in patients with acute and chronic heart failure, and in cardiac arrest. In contrast, upward trends over years were observed in congenital heart disease (p<0.001), stable angina (p<0.001) and across acute coronary syndromes, including NSTEMI (p<0.001), STEMI (p<0.001), and unstable angina (p<0.001). In the overall cohort, older age (OR 1.009; 95%CI 1.008-1.009; p<0.001) and male sex (OR 1.19; 95%CI 1.17-1.21; p<0.001) were associated with referral. Among comorbidities, chronic kidney disease was the strongest predictor (OR 1.42; 95%CI 1.39-1.46; p<0.001), followed by hypertension (OR 1.14; 95%CI 1.12-1.15; p<0.001), and diabetes mellitus (OR 1.05; 95%CI 1.04-1.07; p<0.001). Prior revascularization procedures were associated with lower odds of consultation, for both prior percutaneous coronary intervention (OR 0.52; 95%CI 0.51-0.53; p< 0.001) and prior coronary artery bypass grafting (OR 0.46; 95%CI 0.44-0.47; p<0.001). Considering angiographic findings, multivessel disease with left main coronary artery (LMCA) involvement significantly increased referral likelihood (OR 2.61; 95% CI 2.57-2.66; p<0.001), as did isolated LMCA disease (OR 3.25; 95% CI 3.05-3.47; p<0.001) compared with multivessel disease without LMCA involvement.
Conclusions
In this nationwide cohort, Heart Team referral patterns have changed substantially, particularly for acute coronary syndromes and congenital heart disease, while remaining stable in heart failure. Referral decisions were primarily driven by angiographic complexity, particularly left main and multivessel disease, and selected comorbidities. These findings highlight the importance of multidisciplinary evaluation in contemporary interventional cardiology and the need to optimize Heart Team implementation in real-world practice.Figure 1.Figure 2.