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Real-time heart team decision making maintains noninferiority of 1-year MACCE in complex CADReal-time heart team meetings improve care for coronary artery disease

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Key Takeaway
Note that real-time heart team decision making maintains noninferiority of 1-year MACCE while improving care efficiency.

This randomized controlled trial enrolled 490 patients with de novo left main or 3-vessel coronary artery disease across 3 cardiac centers. Patients were assigned to either a real-time heart team (online meeting during angiography) or a conventional heart team (face-to-face meeting after angiography).

The primary outcome was the noninferiority of 1-year MACCE between the two groups. Results showed 8.2% for the real-time group versus 10.6% for the conventional group (95% CI: -7.61%-2.71%; P for noninferiority < 0.001).

Secondary outcomes highlighted significant improvements in efficiency for the real-time group, including a median waiting time of 2 days versus 5 days (P < 0.001), a recatheterization rate of 12.5% versus 98.9% (P < 0.001), and a specialist high workload rate of 5.3% versus 29.0% (P < 0.001). Additionally, the real-time group saw an 18.0% reduction in PCI hospitalization costs (P < 0.001).

Process metrics showed that while chief surgeon participation was higher in the real-time group (26.5% vs 18.8%), multidisciplinary synchronous shared decision making was lower (2.0% vs 11.5%). Limitations include insufficient shared decision making in the real-time cohort and a need for better intercenter generalizability.

How this fits prior evidence

How this fits prior evidence: This study addresses gaps in operational workflow for complex coronary artery disease management. While previous coverage focused on clinical interventions like colchicine to reduce MACE or HIIE to improve vascular function, this trial specifically evaluates the organizational impact of real-time decision-making. It confirms that remote, real-time coordination can maintain noninferiority in 1-year MACCE (8.2% vs 10.6%) while significantly improving logistical metrics like waiting time and cost compared to traditional methods.

When a patient has complex heart disease, every minute counts. Doctors often have to make split-second decisions about the best way to treat blocked arteries. A new study looked at how 'real-time' decision making—where specialists join an online meeting during the procedure—compares to the traditional method of meeting face-to-face after the surgery is done.

Researchers followed 490 patients with severe coronary artery disease across three centers. They found that the real-time approach was just as safe as the traditional way, with similar rates of major complications over one year. However, the real-time method significantly improved how the hospital functioned. Patients in the real-time group waited a median of 2 days for their final therapy, compared to 5 days for those in the conventional group. It also led to lower costs and less heavy workloads for specialists.

While the results are promising for hospital efficiency, there is a catch. The study noted that while the real-time team worked faster and more efficiently, they actually had lower rates of shared decision-making compared to the traditional method. Because this was done across only three centers, more research is needed to see if these results hold true in different types of hospitals.

What this means for you:
Real-time heart team meetings offer a faster, more efficient way to treat complex heart disease without sacrificing safety.

Common questions

Is the real-time heart team approach safe for patients?

Yes. The study found that the real-time approach was not inferior to traditional methods in terms of safety. Over one year, the rate of major complications (MACCE) was 8.2% for the real-time group and 10.6% for the conventional group.

How does this method improve the speed of care?

The real-time approach significantly improved efficiency. Patients in the real-time group had a median wait time of 2 days for final therapy, while those in the traditional group waited 5 days.

Does this method reduce the workload on medical staff?

Yes, it does. The study showed that the specialist high workload rate dropped from 29.0% in the conventional group to just 5.3% in the real-time group.

Study Details

Study typeRct
Sample sizen = 245
EvidenceLevel 2
Follow-up12.0 mo
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: The routine implementation of heart teams for patients with complex coronary artery disease (CAD) is challenging due to the insufficient multidisciplinary specialist resources for face-to-face discussion. A real-time heart team during the angiography, based on an online meeting, offers the potential to efficiently integrate resources. OBJECTIVES: In this study, we sought to evaluate the implementation value and safety of a "real-time heart team" decision making approach. METHODS: This noninferiority randomized controlled trial enrolled patients with de novo left main or 3-vessel CAD at 3 cardiac centers. 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). 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). 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. RESULTS: Overall, 490 complex CAD patients were included, with 245 patients in each group. 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. 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. 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). The proportions of PCI, coronary artery bypass grafting, and medical therapy were similar between the 2 groups (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. However, insufficient shared decision making and intercenter generalizability should be optimized before widespread implementation of this approach. (Feasibility and Effectiveness of a Real-Time Heart Team Approach in Complex CAD [EHEART; NCT05514210]).
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