Last month I discussed the question, “What is the standard of care?” I contrasted what is done in the community with the expert opinion expressed in guidelines and pointed out how often they differ. That discussion centered on elective patients found to have advanced multivessel or left main coronary disease on diagnostic coronary angiography. Ad hoc percutaneous coronary intervention (PCI) at the time of that angiogram is commonly performed in these patients, making me wonder if the “heart team” really exists. Guidelines promote it, but we seldom use it.