The Heart Team for Coronary Revascularization Decisions

Metkus, Thomas S.; Beckie, Theresa M.; Cohen, Mauricio G.; Fremes, Stephen E.; Mehran, Roxana; Sellke, Frank W.; Lawton, Jennifer S.; Holland, Jacqueline E. Tamis

doi:10.1016/j.jaccas.2021.12.005

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…This is in accordance with the European guidelines for myocardial revascularization [2]. It should be noted that the US guidelines for coronary artery revascularization only define the stenosis range between 40 and 69% as "angiographically intermediate" [1]. This was the case in just a bit over 60% of lesions of our registry.…”

Section: Use Of Coronary Physiologysupporting

confidence: 86%

“…Current guidelines recommend the use of coronary physiology to guide the revascularization of angiographically intermediate stenoses in patients presenting with CCS [1][2][3]. Accordingly, over ¾ of patients, in whom an invasive pressure index was measured, presented with CCS in this registry, which is largely in agreement with previous registries [10][11][12][13].…”

Section: Use Of Coronary Physiologysupporting

confidence: 81%

“…Similar observations have been made in the ERIS study [22]. If lesions are not physiologically relevant according to the FFR or iFR measurement, current guidelines recommend deferring revascularization in angiographically intermediate stenoses [1,2]. This has been shown to avoid unnecessary revascularization and thereby its procedure-related complications [4,5].…”

Section: Use Of Coronary Physiologysupporting

confidence: 62%

“…In angiographically intermediate coronary stenoses, current guidelines recommend the use of coronary physiology, particularly fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), to guide revascularization decisions [1][2][3]. In numerous trials, FFR-guided revascularization has been shown to significantly reduce the rate of major adverse cardiac events as compared to a purely angiography-guided revascularization approach [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…In numerous trials, FFR-guided revascularization has been shown to significantly reduce the rate of major adverse cardiac events as compared to a purely angiography-guided revascularization approach [4,5]. Two large randomized controlled trials initially demonstrated noninferiority of iFR to FFR [6,7], so that the adenosine-independent pressure index is currently equally recommended for the physiological assessment of coronary lesions [1][2][3]. Of note, the pooled 5-year outcome data of the same trials suggest inferiority of iFR over FFR regarding all-cause mortality [8,9], but the interpretation of this data in a clinical context remains debated [9].…”

Section: Introductionmentioning

confidence: 99%

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Use of coronary physiology to guide revascularization in clinical practice: results of the F(FR)2 registry

Altstidl,

Achenbach,

Feyrer

et al. 2024

Clin Res Cardiol

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Background Despite the recommendation of coronary physiology to guide revascularization in angiographically intermediate stenoses without established correlation to ischemia, its uptake in clinical practice is slow. Aims This study aimed to analyze the use of coronary physiology in clinical practice. Methods Based on a multicenter registry (Fractional Flow Reserve Fax Registry, F(FR)2, ClinicalTrials.gov identifier NCT03055910), clinical use, consequences, and complications of coronary physiology were systematically analyzed. Results F(FR)2 enrolled 2,000 patients with 3,378 intracoronary pressure measurements. Most measurements (96.8%) were performed in angiographically intermediate stenoses. Out of 3,238 lesions in which coronary physiology was used to guide revascularization, revascularization was deferred in 2,643 (78.2%) cases. Fractional flow reserve (FFR) was the most common pressure index used (87.6%), with hyperemia induced by an intracoronary bolus of adenosine in 2,556 lesions (86.4%) and intravenous adenosine used for 384 measurements (13.0%). The route of adenosine administration did not influence FFR results (change-in-estimate -3.1% for regression model predicting FFR from diameter stenosis). Agreement with the subsequent revascularization decision was 93.4% for intravenous and 95.0% for intracoronary adenosine (p = 0.261). Coronary artery occlusion caused by the pressure wire was reported in two cases (0.1%) and dissection in three cases (0.2%), which was fatal once (0.1%). Conclusions In clinical practice, intracoronary pressure measurements are mostly used to guide revascularization decisions in angiographically intermediate stenoses. Intracoronary and intravenous administration of adenosine seem equally suited. While the rate of serious complications of wire-based intracoronary pressure measurements in clinical practice seems to be low, it is not negligible. Graphical abstract

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Section: Use Of Coronary Physiologysupporting

confidence: 86%