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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline CLINICAL STATEMENTS AND GUIDELINES Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 January 18, 2022 when scientific data support a treatment, but the patient prefers an alternative treatment; in 1 study, patients preferred PCI over CABG, even when the risk of death with PCI was double the risk with CABG.26 3 PREPROCEDURAL ASSESSMENT AND THE HEART TEAM 3.1 The Heart Team Recommendation for the Heart Team Referenced studies that support the recommendation are summarized in Online Data Supplement 2. COR LOE Recommendation 1 B-NR 1. In patients for whom the optimal treatment strategy is unclear, a Heart Team approach that includes representatives from interventional cardiology, cardiac surgery, and clinical cardiology is recommended to improve patient outcomes.1-7 Synopsis The multidisciplinary Heart Team, which involves the cardiologist, cardiac surgeon, and other specialists, has become a critical component of the revascularization decision. Initially, the Heart Team approach to decision-making for coronary disease arose within the context of randomized trials comparing PCI with CABG to ensure selected patients were equally suited for either strategy before randomization.8 Subsequently, the Heart Team has become an important paradigm in clinical practice, emphasizing the importance of team consensus on the optimal approach to revascularization. Ideal situations for Heart Team consideration include patients with complex coronary disease, comorbid conditions that could impact the success of the revascularization strategy, and other clinical or social situations that may impact outcomes (Figure 2 and Table 4). The Heart Team process should rest on the principles of collegiality, mutual respect, and commitment to excellence. The logistics of convening the Heart Team should depend on local resources and workflows. Models include daily to weekly scheduled meetings and ad hoc activation.1,2,4,6,9 Remote conferences have also been advocated.9 Additionally, there should be a process for rapid activation of the Heart Team for urgent or emergency clinical situations. Recommendation-Specific Supporting Text 1. Observational studies using the Heart Team have included interventional cardiology, cardiac surgery, and noninvasive cardiologists1-4,6 Additional professionals who offer input may include the patient’s primary physician, as well as palliative care, critical care, anesthesiology, and imaging specialists. Observational studies have demonstrated favorable outcomes when the Heart Team was used in cases of unprotected left main disease, triplevessel disease, double-vessel disease involving the proximal left anterior descending (LAD) artery, or single-vessel disease involving the proximal LAD artery in the context of diabetes, or in cases in which the referring physician requested such evaluation.5-7,10,11 Heart Team decisions are generally reproducible4 and associated with good outcomes.2,6 Figure 2. Phases of Patient-Centric Care in the Treatment of Coronary Artery Disease. CV indicates cardiovascular; SIHD, stable ischemic heart disease; and STEMI, ST-segment–elevation myocardial infarction. Downloaded from http://ahajournals.org by on October 7, 2026