Clinical expert consensus statement on best practices in the cardiac catheterization laboratory: Society for cardiovascular angiography and interventions

Naidu, Srihari S.; Rao, Sunil V.; Blankenship, James C.; Cavendish, Jeffrey J.; Farah, Tony; Moussa, Issam; Rihal, Charanjit S.; Srinivas, Vankeepuram S.; Yakubov, Steven J.

doi:10.1002/ccd.24311

Cited by 62 publications

(37 citation statements)

References 71 publications

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“…18 Invasive coronary angiograms were transferred to a central angiographic core laboratory (University of British Columbia, Vancouver, Canada) for blinded quantitative coronary angiography of all vessels using commercially available software (Discovery Quinton).…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography

Min¹,

Leipsic²,

Pencina³

et al. 2012

JAMA

1,038

547

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ORONARY COMPUTED TOMOgraphic (CT) angiography is a noninvasive test that enables direct visualization of coronary artery disease (CAD) and correlates favorably with invasive coronary angiography (ICA) for measures of stenosis severity. 1 However, CT cannot determine the hemodynamic significance of CAD, and even among CTidentified obstructive stenoses confirmed by ICA, fewer than half are ischemia-causing. 2,3 These findings underscore an unreliable relationship of stenosis severity to ischemia and have raised concerns that use of CT may pre-cipitate unnecessary ICA and coronary revascularization for patients who do not have ischemia. 4,5 These concerns stem from recent randomized trials that have identified no survival benefit for patients who undergo angiographically based coronary revascularization. 6,7 As an ad-junct to ICA, fractional flow reserve (FFR) has served as a useful tool to determine the likelihood that a coronary For editorial comment see p 1269.

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Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography

Min¹,

Leipsic²,

Pencina³

et al. 2012

JAMA

1,038

547

View full text Add to dashboard Cite

show abstract

“…ICA had been performed according to standard practice (11) and interpreted for stenosis by local physicians who made all clinical decisions, including whether to pursue revascularization. As with CTA, a severe stenosis constituted a per-patient “positive” ICA result.…”

Section: Methodsmentioning

confidence: 99%

Noninvasive FFR Derived From Coronary CT Angiography

Ferencik

Roberts

et al. 2017

JACC: Cardiovascular Imaging

187

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Objectives To determine whether noninvasive fractional flow reserve derived from computed tomography (FFRCT) predicts coronary revascularization and outcomes and whether its addition improves efficiency of referral to invasive coronary angiography (ICA) after coronary CT angiography (CTA). Background FFRCT may improve the efficiency of an anatomic CTA strategy for stable chest pain. Methods Observational cohort study of patients with stable chest pain enrolled in the PROMISE trial referred to ICA within 90 days after CTA. FFRCT was measured at a blinded core lab, and FFRCT results were unavailable to caregivers. We determined the agreement of FFRCT (positive if ≤0.80) with stenosis on CTA and ICA (positive if ≥50% left main or ≥70% other coronary artery), and predictive value for a composite of coronary revascularization or MACE (death, myocardial infarction, or unstable angina). We retrospectively assessed whether adding FFRCT ≤0.80 as a gatekeeper could improve efficiency of referral to ICA, defined as decreased rate of ICA without ≥50% stenosis and increased ICA leading to revascularization. Results FFRCT was calculated in 67% (181/271) of eligible patients (mean age 62 years, 36% women). FFRCT was discordant with stenosis in 31% (57/181) for CTA and 29% (52/181) for ICA. Most patients undergoing coronary revascularization had FFRCT ≤0.80 (91%, 80/88). FFRCT ≤0.80 was a significantly better predictor for revascularization or MACE than severe CTA stenosis (HR 4.3 [95% CI 2.4–8.9] versus 2.9 [1.8–5.1]; p=0.033). Reserving ICA for patients with FFRCT ≤0.80 could decrease ICA without ≥50% stenosis by 44%, and increase the proportion of ICA leading to revascularization by 24%. Conclusion In this hypothesis-generating study of patients with stable chest pain referred to ICA from CTA, FFRCT ≤0.80 was a better predictor of revascularization or MACE than severe stenosis on CTA. Adding FFRCT may improve efficiency of referral to ICA from CTA alone.

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“…19 Invasive coronary angiograms were transferred to a central angiographic core laboratory (University of British Columbia, Vancouver, Canada) for blinded quantitative coronary angiography of all vessels using commercially available software (Discovery Quinton).…”

Section: Image Acquisition and Analysis For Icamentioning

confidence: 99%