Patterson T, et al. - Via this observational study done at St Thomas’ Hospital (London, UK), researchers investigated features and outcomes in patients with complex coronary artery disease (CAD) after Heart Team (HT) discussion. Optimal medical therapy (OMT) alone, OMT+percutaneous coronary intervention (PCI), or OMT+coronary artery bypass grafting defined HT strategy. Older patients with chronic kidney disease and peripheral vascular disease had lower chances of undergoing PCI vs OMT as seen in multinomial logistic regression analysis. They noted lower odds of undergoing coronary artery bypass grafting vs OMT when cardiogenic shock and left ventricular dysfunction were present, while these odds were higher in younger patients with 3-vessel CAD. In the OMT cohort, the OMT+PCI cohort, and the OMT+coronary artery bypass grafting cohort, the observed 3-year survival was 60.8%, 84.3%, and 90.2%, respectively. A careful selection process part of the HT approach, leading to appropriate patient-specific decision making and good long-term outcomes in patients with complex CAD.