Ischemia-Guided Percutaneous Coronary Intervention for Patients With Stable Coronary Artery Disease

Kim, Young‐Hak; Park, Seung‐Jung

doi:10.1253/circj.cj-13-0376

Cited by 14 publications

(8 citation statements)

References 54 publications

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“…Accumulating evidences have demonstrated that vascular revascularization strategies targeting to ischemia-causing stenosis maximizes the benefit of PCI and coronary artery bypass grafting (CABG) while minimizing the risk. [ 25 , 26 ]…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

Man

Hu²,

Zhao³

et al. 2016

Medicine

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Background:The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference.Methods:We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR. We used a random-effects covariate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR). Overall test performance was summarized by the summary receiver operating characteristic curve (sROC) and the area under the curve (AUC).Results:Eight studies with 1611 subjects were included in the meta-analysis. The pooled sensitivity, specificity, LR+, LR−, and DOR for iFR were respectively 73.3% (70.1–76.2%), 86.4% (84.3–88.3%), 5.71 (4.43–7.37), 0.29 (0.22–0.38), and 20.54 (16.11–26.20). The area under the summary receiver operating characteristic curves for iFR was 0.8786. No publication bias was identified.Conclusion:The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

Man

Hu²,

Zhao³

et al. 2016

Medicine

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“…Measurement of FFR by ICA is the gold standard for diagnosis of coronary stenosis causing lesion-specific ischemia. [ 5 ] The FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) study has shown that invasive FFR-guided decisions about revascularization improve event-free survival compared with coronary angiography-guided decisions alone. [ 6 ] Consequently, FFR is the accepted reference standard for assessing the functional significance of CAD in a lesion-specific manner.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard

et al. 2016

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Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull’s eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73–0.90) and 0.70 (0.61–0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.

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“… 1) 2) 3) Recent advances in the invasive assessment of coronary physiology have resulted in large-scale clinical trials to verify this important concept and have allowed interventional cardiologists to gain useful insights into optimal treatment strategies for CAD and improve cost-effectiveness. 4) 5) 6) 7) In particular, fractional flow reserve (FFR) measured by pressure-wire technology provides useful guidance for determining treatment in patient subsets for various coronary lesions. Therefore, FFR is now recommended as an approach for detecting ischemia-producing lesions when objective evidence of inducible ischemia is not available.…”

Section: Introductionmentioning

confidence: 99%

Ischemia-based Coronary Revascularization: Beyond Anatomy and Fractional Flow Reserve

et al. 2018

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Treatment strategies for patients with coronary artery disease (CAD) should be based on objective evidence of inducible ischemia in the subtended myocardium to improve clinical outcomes, symptoms, and cost-effectiveness. Fractional flow reserve (FFR) is the most verified index to-date for invasively evaluating lesion-specific myocardial ischemia. Favorable results from large clinical trials that applied FFR-guided percutaneous coronary intervention (PCI) prompted changes in coronary revascularization guidelines to emphasize the importance of this ischemia-based strategy using invasive coronary physiology. However, the frequency of functional evaluations is lacking in daily practice, and visual assessment still dominates treatment decisions in CAD patients. Despite recent efforts to integrate functional and anatomical assessments for coronary stenosis, there is considerable discordance between the 2 modalities, and the diagnostic accuracy of simple parameters obtained from current imaging tools is not satisfactory to determine functional significance. Although evidence that supports or justifies anatomy-guided PCI is more limited, and FFR-guided PCI is currently recommended, it is important to be aware of conditions and factors that influence FFR for accurate interpretation and application. In this article, we review the limitations of the current anatomy-derived evaluation of the functional significance of coronary stenosis, detail considerations for the clinical utility of FFR, and discuss the importance of an integrated physiologic approach to determine treatment strategies for CAD patients.

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Ischemia-Guided Percutaneous Coronary Intervention for Patients With Stable Coronary Artery Disease

Cited by 14 publications

References 54 publications

Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

Diagnostic Performance of First-Pass Myocardial Perfusion Imaging without Stress with Computed Tomography (CT) Compared with Coronary CT Angiography Alone, with Fractional Flow Reserve as the Reference Standard

Ischemia-based Coronary Revascularization: Beyond Anatomy and Fractional Flow Reserve

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