Matteo Tebaldi1, Simone Biscaglia1, Massimo Fineschi2, Giuseppe Musumeci3, Alfredo Marchese4, Antonio Maria Leone5, Marco Luciano Rossi6, Giulio Stefanini6, Antongiulio Maione7, Alberto Menozzi8, Fabio Tarantino9, Veronica Lodolini1, Francesco Gallo1, Emanuele Barbato10, Giuseppe Tarantini11, Gianluca Campo12. 1. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy. 2. Department of Cardiovascular Diseases, University Hospital Santa Maria alle Scotte, Siena, Italy. 3. S.C. Cardiologia, A.O. Santa Croce e Carle, Cuneo, Italy. 4. Interventional Cardiology Unit, Anthea Hospital, Bari, Italy. 5. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 6. Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy. 7. Department of Medicine and Surgery, University of Salerno, Salerno, Italy. 8. Unità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria, Parma, Italy. 9. Cardiology Unit, Ospedale G.B. Morgagni, Forlì, Italy. 10. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 11. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 12. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy; Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy. Electronic address: cmpglc@unife.it.
Abstract
OBJECTIVES: The aims of the ERIS (Evolving Routine Standards of FFR Use) study are to describe the current use of invasive coronary physiology assessment and discern the reasons for its nonuse in daily practice. BACKGROUND: Adoption of coronary physiology guidance in the catheterization laboratory varies among countries, centers, and operators. METHODS: ERIS is an investigator-driven, nationwide, prospective, cross-sectional study involving 76 Italian catheterization laboratories. Each center had a 60-day window to include consecutive cases that fulfilled the inclusion and exclusion criteria. Two pre-specified groups were enrolled: 1) patients who had operators apply fractional flow reserve or instantaneous wave-free ratio assessment (physiology assessment group); and 2) patients who had operators decide not to perform fractional flow reserve or instantaneous wave-free ratio assessment, although the patients met the inclusion and exclusion criteria (visual estimation group). RESULTS: Overall, 1,858 cases were included (physiology assessment group, n = 1,177; visual estimation group, n = 681). Physiology-based guidance was used in 7% and 13% of the total volume of angiographic and percutaneous coronary interventions, respectively. Its use was in line with European and American guidelines in 48% of the cases (n = 569). Physiology guidance was used in a consistent number of patients with acute coronary syndromes (n = 529 [45%]). The main reason for not using physiology guidance was the operator's confidence that clinical and angiographic data alone were sufficient. CONCLUSIONS: Use of coronary physiology assessment in daily practice meets the current guideline indications in approximately 50% of cases. The major limiting factor for the adoption of physiology guidance was the operator's confidence in visual assessment alone. (Evolving Routine Standards of FFR Use [ERIS]; NCT03082989).
OBJECTIVES: The aims of the ERIS (Evolving Routine Standards of FFR Use) study are to describe the current use of invasive coronary physiology assessment and discern the reasons for its nonuse in daily practice. BACKGROUND: Adoption of coronary physiology guidance in the catheterization laboratory varies among countries, centers, and operators. METHODS:ERIS is an investigator-driven, nationwide, prospective, cross-sectional study involving 76 Italian catheterization laboratories. Each center had a 60-day window to include consecutive cases that fulfilled the inclusion and exclusion criteria. Two pre-specified groups were enrolled: 1) patients who had operators apply fractional flow reserve or instantaneous wave-free ratio assessment (physiology assessment group); and 2) patients who had operators decide not to perform fractional flow reserve or instantaneous wave-free ratio assessment, although the patients met the inclusion and exclusion criteria (visual estimation group). RESULTS: Overall, 1,858 cases were included (physiology assessment group, n = 1,177; visual estimation group, n = 681). Physiology-based guidance was used in 7% and 13% of the total volume of angiographic and percutaneous coronary interventions, respectively. Its use was in line with European and American guidelines in 48% of the cases (n = 569). Physiology guidance was used in a consistent number of patients with acute coronary syndromes (n = 529 [45%]). The main reason for not using physiology guidance was the operator's confidence that clinical and angiographic data alone were sufficient. CONCLUSIONS: Use of coronary physiology assessment in daily practice meets the current guideline indications in approximately 50% of cases. The major limiting factor for the adoption of physiology guidance was the operator's confidence in visual assessment alone. (Evolving Routine Standards of FFR Use [ERIS]; NCT03082989).
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