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Riojas et al. Vessel Plus 2024;8:6 https://dx.doi.org/10.20517/2574-1209.2023.122 Page 5 of 16

Table 1. Factors considered by the Heart Team, adapted from the 2021 ACC/AHA/SCAI Guidelines [1]
Comorbidities
Diabetes
Systolic dysfunction
Coagulopathy
Valvular heart disease
Frailty
Malignant neoplasm
End-stage renal disease
Chronic obstructive pulmonary disease
Immunosuppression
Debilitating neurological disorders
Liver disease/cirrhosis
Prior CVA
Calcified/porcelain aorta
Aortic aneurysm
Procedural factors
Local and regional outcomes
Access site for PCI
Surgical risk
PCI risk
Patient factors
Unstable presentation or shock
Patient preferences
Inability or unwillingness to adhere to DAPT
Patient social support
Religious beliefs
Patient education, knowledge, and understanding

and EUROSCORE I and II contribute to the analysis of certain interventions, they do not encompass all of
the clinical factors that may impact the potential outcome of an intervention. The SYNTAX II 2020 score is
now available with the addition of clinical parameters in addition to coronary anatomy. As recommended in
the 2021 ACC/AHA/SCAI guidelines, a heart team should consider these clinical variables that may impact
the outcomes of revascularizaiton . There may also be unique variables to consider, especially if they will
[1]
affect the technical conduct of intervention. For example, a heart team discussion may be useful if a
potential surgical patient has a porcelain aorta, a hostile chest, a lack of conduit, or anticipated difficult
targets for grafting. Some comorbidities that may affect decision making include uncontrolled diabetes,
severely decreased systolic function, frailty, advanced liver disease, advanced cancer, and other conditions
[Table 1]. Furthermore, patients, primary care providers, and referring cardiologists should have the ability
to request a multidisciplinary discussion as the situation dictates.

ATTRIBUTES OF A SUCCESSFUL HEART TEAM
The multidisciplinary team model has been used in specialties other than cardiovascular medicine,
including transplant medicine, oncology, critical care, and others. Within cardiovascular care,
multidisciplinary teams have been used in congenital heart surgery, structural heart, advanced heart failure,
cardiogenic shock, and others. One proposal for operationalizing a heart team is to use the “Five Star”
[41]
model . Teams would (1) adopt an institutional protocol; (2) utilize a template and scoring system; (3)
foster diversity of opinion and consensus of recommendations; (4) create an official recommendation to