Impact of intracoronary assessments on revascularization decisions: A contemporary evaluation.
clinical decision making
fractional flow reserve
intravascular ultrasound
optical coherence tomography
percutaneous coronary intervention
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
21
02
2022
accepted:
06
09
2022
pubmed:
20
10
2022
medline:
1
12
2022
entrez:
19
10
2022
Statut:
ppublish
Résumé
To investigate the real-world implementation of intracoronary assessment (ICA) techniques and evaluate their impact on clinical decisions regarding the management of coronary artery disease (CAD) in contemporary practice. Coronary angiogram is the gold standard used to diagnose vessel stenosis and guide percutaneous coronary intervention (PCI); however, it is limited by its two-dimensional imaging capabilities. ICA techniques like intravascular ultrasound and optical coherence tomography capture the vessel in three-dimensional images. Comparatively, fractional flow reserve provides information on the physiologic significance of coronary stenosis. Both techniques may improve PCI outcomes if they routinely change physician behavior. Patients who underwent ICA between August 2015 and March 2020 were included in the study. The primary outcome was the clinical impact of ICA on physician clinical decision making of a stenotic vessel. The secondary outcome was the clinical changes that occurred following ICA. A total of 1135 patients were included in the study. Physiologic assessment (PA) and image assessment (IA) were performed in 61.4% and 38.6% respectively. Management plans were changed in 38.1% and 23.9% of patients who received PA and IA. Over half of the management change resulted in physicians deciding to not intervene on the stenotic vessel. One-year outcome of these decisions showed no significant increase in major adverse cardiac events (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.40-1.15; p = 0.15) or unplanned revascularization (HR, 0.78; 95% CI, 0.35-1.74; p = 0.55) suggesting reliance on PA/IA data did not increase risk. Selected ICA alters physician management of CAD in one-third of patients being evaluated for revascularization-typically leading to fewer interventions. All cause death is numerally lower in patients that received a change in management. However, the 1-year outcome of these altered decisions does not appear to be significantly different.
Sections du résumé
OBJECTIVES
To investigate the real-world implementation of intracoronary assessment (ICA) techniques and evaluate their impact on clinical decisions regarding the management of coronary artery disease (CAD) in contemporary practice.
BACKGROUND
Coronary angiogram is the gold standard used to diagnose vessel stenosis and guide percutaneous coronary intervention (PCI); however, it is limited by its two-dimensional imaging capabilities. ICA techniques like intravascular ultrasound and optical coherence tomography capture the vessel in three-dimensional images. Comparatively, fractional flow reserve provides information on the physiologic significance of coronary stenosis. Both techniques may improve PCI outcomes if they routinely change physician behavior.
METHODS
Patients who underwent ICA between August 2015 and March 2020 were included in the study. The primary outcome was the clinical impact of ICA on physician clinical decision making of a stenotic vessel. The secondary outcome was the clinical changes that occurred following ICA.
RESULTS
A total of 1135 patients were included in the study. Physiologic assessment (PA) and image assessment (IA) were performed in 61.4% and 38.6% respectively. Management plans were changed in 38.1% and 23.9% of patients who received PA and IA. Over half of the management change resulted in physicians deciding to not intervene on the stenotic vessel. One-year outcome of these decisions showed no significant increase in major adverse cardiac events (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.40-1.15; p = 0.15) or unplanned revascularization (HR, 0.78; 95% CI, 0.35-1.74; p = 0.55) suggesting reliance on PA/IA data did not increase risk.
CONCLUSION
Selected ICA alters physician management of CAD in one-third of patients being evaluated for revascularization-typically leading to fewer interventions. All cause death is numerally lower in patients that received a change in management. However, the 1-year outcome of these altered decisions does not appear to be significantly different.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
955-963Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Ali ZA, Karimi Galougahi K, Maehara A, et al. Intracoronary optical coherence tomography 2018. JACC Cardiovasc Interv. 2017;10(24):2473-2487.
Topol EJ, Nissen SE. Our preoccupation with coronary luminology. Circulation. 1995;92(8):2333-2342.
Schoenhagen P, Nissen S. Understanding coronary artery disease: tomographic imaging with intravascular ultrasound. Heart. 2002;88(1):91-96.
Ochijewicz D, Tomaniak M, Koltowski L, Rdzanek A, Pietrasik A, Kochman J. Intravascular imaging of coronary artery disease. J Cardiovasc Med. 2017;18(10):733-741.
Bech GJW, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis. Circulation. 2001;103(24):2928-2934.
Pijls NHJ, de Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334(26):1703-1708.
Darmoch F, Alraies MC, Al-Khadra Y, Moussa Pacha H, Pinto DS, Osborn EA. Intravascular ultrasound imaging-guided versus coronary angiography-guided percutaneous coronary intervention: a systematic review and meta-analysis. J Am Heart Assoc. 2020;9(5):e013678.
Zhang J, Gao X, Kan J, et al. Intravascular ultrasound versus angiography-guided drug-eluting stent implantation. J Am Coll Cardiol. 2018;72(24):3126-3137.
Parise H, Maehara A, Stone GW, Leon MB, Mintz GS. Meta-analysis of randomized studies comparing intravascular ultrasound versus angiographic guidance of percutaneous coronary intervention in pre-drug-eluting stent era. Am J Cardiol. 2011;107(3):374-382.
Pijls NHJ, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis. J Am Coll Cardiol. 2007;49(21):2105-2111.
Buccheri S, Franchina G, Romano S, et al. Clinical outcomes following intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention with stent implantation. JACC Cardiovasc Interv. 2017;10(24):2488-2498.
Oemrawsingh PV, Mintz GS, Schalij MJ, Zwinderman AH, Jukema JW, Wall EEvd. Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses. Circulation. 2003;107(1):62-67.
Park SJ, Kim YH, Park DW, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009;2(3):167-177.
Simard T, Jung R, Labinaz A, et al. Evaluation of plasma adenosine as a marker of cardiovascular risk: analytical and biological considerations. J Am Heart Assoc. 2019;8(15):e012228.
Jung RG, Simard T, Di Santo P, et al. Evaluation of plasminogen activator inhibitor-1 as a biomarker of unplanned revascularization and major adverse cardiac events in coronary angiography and percutaneous coronary intervention. Thromb Res. 2020;191:125-133.
Simard T, Jung RG, Di Santo P, et al. Performance of plasma adenosine as a biomarker for predicting cardiovascular risk. Clin Transl Sci. 2021;14(1):354-361.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-2035.
Wijns W, Shite J, Jones MR, et al. Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study. Eur Heart J. 2015;36(47):3346-3355.
Prati F, Di Vito L, Biondi-Zoccai G, et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-optimisation of percutaneous coronary intervention (CLI-OPCI) study. EuroIntervention. 2012;8(7):823-829.
Maehara A, Ben-Yehuda O, Ali Z, et al. Comparison of stent expansion guided by optical coherence tomography versus intravascular ultrasound. JACC Cardiovasc Interv. 2015;8(13):1704-1714.
Chamié D, Bezerra HG, Attizzani GF, et al. Incidence, predictors, morphological characteristics, and clinical outcomes of stent edge dissections detected by optical coherence tomography. JACC Cardiovasc Interv. 2013;6(8):800-813.
De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367(11):991-1001.
Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213-224.
Curzen NP, Nolan J, Zaman AG, Nørgaard BL, Rajani R. Does the routine availability of CT-derived FFR influence management of patients with stable chest pain compared to CT angiography alone? JACC Cardiovasc Imaging. 2016;9(10):1188-1194.
Gosling RC, Adam Z, Barmby DS, et al. The impact of virtual fractional flow reserve and virtual coronary intervention on treatment decisions in the cardiac catheter laboratory. Can J Cardiol. 2021;37(10):1530-1538.
Fearon WF, Zimmermann FM, de Bruyne B, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386(2):128-137.