Treatment Decisions for Multi-vessel CAD

Multi-vessel coronary artery disease can be treated through percutaneous coronary
intervention, coronary artery bypass grafting, or medical therapy. Treatments have risk
benefit tradeoffs, making patient preference integral to the treatment decision. The
Multi-vessel Coronary Artery Disease Option Grid patient decision aid was developed to
improve the decision making process for patients and clinicians.

Objectives:

1. Evaluate The Multi-vessel Coronary Artery Disease Option Grid impact on patient
treatment decisional conflict, knowledge, and shared decision making.

The randomized controlled trial will compare validated and standardized measures of
patient decisional conflict, shared decision making, and condition specific treatment
knowledge between Option Grid and usual care patients. The investigators hypothesize
Option Grid patients will have improvements in patient decisional conflict, shared
decision making, and knowledge compared to usual care patients. Baseline feasibility
enrollment at each site prior to randomization will be used to identify current
treatment patterns, and prepare intervention delivery and fidelity. Registry data will
be used to identify patient treatment received and compared between Option Grid and
usual care arms.

2. Examine the physician and patient process of and factors influencing Multi-vessel
Coronary Artery Disease Option Grid use.

Semi-structured interviews and process evaluations will be used to describe Option Grid use
and experience and identify factors that are associated with beneficial Option Grid use.

Inclusion Criteria:

- Stable multi-vessel coronary artery disease diagnosed by coronary angiography defined
as left main disease (>50% stenosis) or multi-vessel coronary artery disease (>70%
stenosis in two or more coronary arteries)

- At relative equipoise for at least two potential treatment options, in which the
treating cardiologist or surgeon has determined the treatments are anatomically
feasible and safe.

Exclusion Criteria:

- Prior coronary artery bypass grafting

- Unable to read or write English

- Not cognitively able to participate in the Option Grid as determined by clinician