It's good to talk! Changes in Coronary Revascularisation Practice In PCI Centres without Onsite Surgical Cover and the Impact of the Lifestream™ Angiography Video Conferencing System.

Rick A Veasey (1) , Jonathan Hyde (2) , Michael Lewis (2) , Uday Trivedi (2) , Andrew Cohen (2) , Guy Lloyd (3) , Stephen Furniss (3) , Nikhil Patel (3) , Neil Sulke (3)

1 Cardiac Department
2 Department of Cardiothoracic Surgery
3 Department of Cardiology

Introduction Percutaneous coronary intervention (PCI) activity has increased more than 6 fold in the last 15 years. Increased demand has been met by PCI centres without on-site surgical facilities. To improve communication between cardiologists and surgeons at a remote centre, we have developed a video conferencing system using standard internet links. The effect of this video data link (VDL) on referral pattern and patient selection for revascularisation was assessed prospectively after introduction of a joint cardiology conference (JCC) using the system. Methods Between 1st October 2005 and 31st March 2007, 1346 patients underwent diagnostic coronary angiography (CA). Of these, 114 patients were discussed at a cardiology conference (CC) attended by 3 consultant cardiologists (pre-VDL). In April 2007 the VDL system was introduced. Between 1st April 2007 and 30th September 2008, 1428 patients underwent diagnostic CA. Of these, 120 patients were discussed at a JCC attended by 4 consultant cardiologists and 2 consultant cardiothoracic surgeons (post-VDL). Following case-matching for patient demographics and coronary artery disease (CAD) severity and distribution, we assessed the effect upon management decisions arising from both the pre- and post-VDL JCC meetings. Results When comparing decision-making outcomes of post-VDL JCC with pre-VDL CC, significantly fewer patients were recommended for PCI (36.8% v 17.2% respectively, p=0.001) and significantly more patients were recommended for surgery (21.1% v 48.4% respectively, p<0.001). There were no significant differences in waiting times for PCI following JCC discussion, however, waiting times for surgical revascularisation were significantly reduced (140.9 ± 71.8 days vs 99.4 ± 56.6 days respectively, p=0.045). Conclusions The VDL system provides a highly practical method for PCI centres without onsite surgical cover to discuss complex patients requiring coronary revascularisation and significantly increases the number of patients referred for surgical revascularisation rather than PCI.

Mots clés: Medicine

Rick A Veasey, Jonathan Hyde, Michael Lewis, Uday Trivedi, Andrew Cohen, et al.. It's good to talk! Changes in Coronary Revascularisation Practice In PCI Centres without Onsite Surgical Cover and the Impact of the Lifestream™ Angiography Video Conferencing System.. International Journal of Clinical Practice, 2011, 65 (6), pp.658. ⟨10.1111/j.1742-1241.2011.02672.x⟩. ⟨hal-00640465⟩