Real-Time Heart Team for Revascularization in Complex Coronary Artery Disease: The EHEART Randomized Trial.

A real-time heart team during the angiography, based on an online meeting, offers the potential to efficiently integrate resources.

基于在线会议的实时心脏团队在血管造影期间提供了一种高效整合资源的潜力。

In this study, we sought to evaluate the implementation value and safety of a "real-time heart team" decision making approach.

在这项研究中，我们试图评估实时心脏团队决策方法的实施价值和安全性。

Methods

This noninferiority randomized controlled trialenrolled patients with de novo left main or 3-vessel CAD at 3 cardiac centers.

这项非劣效性随机对照试验在3个心脏中心招募了新发左主干或三支血管冠状动脉疾病（CAD）的患者。

Patients were randomly assigned to the conventional heart team group (discussed by a face-to-face meeting after the angiography) or the real-time heart team group (discussed by an online meeting during the angiography).

患者被随机分配到传统心脏团队组（在血管造影后通过面对面会议讨论）或实时心脏团队组（在血管造影期间通过在线会议讨论）。

Implementation value outcomes included care efficiency (waiting time for treatment, recatheterization, specialist workload, and economic outcomes) and process evaluation metrics (discussion adequacy, surgeon participation, and shared decision making).

实施价值结果包括护理效率（治疗等待时间、再导管化、专科工作量和经济结果）和过程评估指标（讨论充分性、外科医生参与度和共同决策）。

The safety outcomes were a composite of 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (including all-cause mortality, myocardial infarction, stroke, unplanned revascularization, and readmission due to reangina) and revascularization decision making.

安全性结果是1年内主要不良心血管和脑血管事件（MACCE）的综合评估（包括全因死亡率、心肌梗死、中风、计划外的血管重建和因再心绞痛的再入院）以及血管重建决策。

Results

Overall, 490 complex CAD patients were included, with 245 patients in each group.

总体而言，共有490名复杂冠状动脉疾病（CAD）患者被纳入研究，每组各有245名患者。

Waiting time for final therapy (median: 2 days [Q1-Q3: 0-7 days] vs 5 days [Q1-Q3: 2-10 days]; P < 0.001), recatheterization rate (12.5% vs 98.9%; P < 0.001), specialist high workload rate (5.3% vs 29.0%; P < 0.001), and percutaneous coronary intervention (PCI) hospitalization cost (percentage of decrease: 18.0%; P < 0.001) were significantly reduced in the real-time group.

实时组的最终治疗等待时间（中位数：2天 [四分位数间距：0-7天] 对比 5天 [四分位数间距：2-10天]；P < 0.001）、再插管率（12.5% 对比 98.9%；P < 0.001）、专家高工作量率（5.3% 对比 29.0%；P < 0.001）以及经皮冠状动脉介入治疗（PCI）住院费用（减少百分比：18.0%；P < 0.001）显著减少。

More discussion time spent (4.0 ± 1.8 min vs 3.4 ± 1.6 min), better specialist satisfaction (based on NASA Task Load Index scale), more chief surgeon participation (26.5% vs 18.8%), but less multidisciplinary synchronous shared decision making (2.0% vs 11.5%) were found in the real-time group.

实时组花费了更多的时间进行讨论（4.0 ± 1.8分钟对比 3.4 ± 1.6分钟），专家满意度更高（基于NASA任务负荷指数量表），首席外科医生的参与度更高（26.5%对比 18.8%），但多学科同步共享决策的参与度较低（2.0%对比 11.5%）。

The real-time heart team group was noninferior to the conventional group in 1-year MACCE (8.2% vs 10.6%; risk difference: -2.45%; 95% CI: -7.61%-2.71%; P for noninferiority < 0.001).

实时心脏团队组在1年主要不良脑血管和心脏事件（MACCE）方面不劣于传统组（8.2% 对比 10.6%；风险差异：-2.45%；95% 置信区间：-7.61%至2.71%；非劣效性检验的P值<0.001）。

The proportions of PCI, coronary artery bypass grafting, and medical therapy were similar between the 2 groups (P = 0.892).

两组在经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术和药物治疗的比例上相似（P = 0.892）。

Conclusions

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.

与传统心脏团队相比，实时心脏团队显著提高了护理效率和流程评估指标，临床结果和决策过程相似。

However, insufficient shared decision making and intercenter generalizability should be optimized before widespread implementation of this approach.

然而，在广泛实施这种方法之前，应优化共享决策的不足和中心间的一般适用性。

(Feasibility and Effectiveness of a Real-Time Heart Team Approach in Complex CAD [EHEART; NCT05514210]).

(复杂冠状动脉疾病中实时心脏团队方法的可行性和有效性 [EHEART; NCT05514210])。