Introduction: The Heart Team concept was developed to provide multidisciplinary shared-decision making in complex cardiac patients. Although given a Class I recommendation by professional societies, clinical outcomes based on Heart Team decisions have not been adequately studied. This analysis was performed to investigate mortality among patients turned down for coronary revascularization by a multidisciplinary Heart Team. Methods: Clinical data on consecutive patients presented at a weekly Heart Team meeting at a quaternary referral center were retrospectively obtained via chart review. The Heart Team consisted of cardiothoracic surgeons, interventional cardiologists, non-invasive cardiologists, and cardiac anesthesiologists. Patients turned down for coronary revascularization by the Heart Team were included. Multivariate logistic regression analysis was performed to identify patient characteristics independently associated with 1-year mortality. Results: Between January 2015 and May 2017, a multidisciplinary Heart Team with a mean attendance of 20.2±4.2 providers evaluated 684 patients to discuss coronary revascularization options. Of these, 135 (19.7%) patients (age 66.1±12.3 years, 68.9% male) were turned down for both surgical and percutaneous coronary revascularization. These patients had an ejection fraction of 44±17% and an STS risk of morbidity and mortality of 18.7±13.5% and 3.3±4.8%, respectively. Following Heart Team turn down for coronary revascularization, 30-day mortality was 6.7% and 1-year mortality was 20.0%. By multivariate logistic regression, end-stage renal disease, inpatient status, and age were the only variables independently associated with 1-year mortality (p<0.05 for all). Conclusions: Patients turned down for coronary revascularization by a multidisciplinary Heart Team may be at particularly high risk of poor clinical outcomes, as we observed 30-day and 1-year mortality rates of 6.7% and 20.0% in these patients, respectively. Additional studies are needed to further characterize clinical outcomes based on Heart Team decisions. [ABSTRACT FROM AUTHOR]