Hak Seung Lee1, Joo Myung Lee2, Chang-Wook Nam3, Eun-Seok Shin4, Joon-Hyung Doh5, Neng Dai6, Martin K C Ng7, Andy S C Yong8, Damras Tresukosol9, Ajit S Mullasari10, Rony Mathew11, Praveen Chandra12, Kuang-Te Wang13, Yundai Chen14, Jiyan Chen15, Kai-Hang Yiu16, Nils P Johnson17, Bon-Kwon Koo18. 1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 4. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea. 5. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. 6. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China. 7. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia. 8. Department of Cardiology, Concord Hospital, Sydney, Australia. 9. Division of Cardiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 10. Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India. 11. Lisie Hospital, Kochi, Kerala, India. 12. Medanta, Gurgaon, India. 13. Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taiwan. 14. Department of Cardiology, Chinese PLA General Hospital, Beijing, China. 15. Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 16. Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China. 17. McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, United States. 18. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. bkkoo@snu.ac.kr.
Abstract
BACKGROUND: Currently, invasive physiologic assessment such as fractional flow reserve is widely used worldwide with different adoption rates around the globe. Patient characteristics and physician preferences often differ in the Asia-Pacific (APAC) region with respect to treatment strategy, techniques, lesion complexity, access to coronary physiology and imaging devices, as well as patient management. Thus, there is a need to construct a consensus document on recommendations for use of physiology-guided percutaneous coronary intervention (PCI) in APAC populations. This document serves as an overview of recommendations describing the best practices for APAC populations to achieve more consistent and optimal clinical outcomes. METHODS AND RESULTS: A comprehensive multiple-choice questionnaire was provided to 20 interven- tional cardiologists from 10 countries in the APAC region. Clinical evidence, tips and techniques, and clinical situations for the use of physiology-guided PCI in APAC were reviewed and used to propose key recommendations. There are suggestions to continue to develop evidence for lesion and patient types that will benefit from physiology, develop directions for future research in health economics and local data, develop appropriate use criteria in different countries, and emphasize the importance of education of all stakeholders. A consensus recommendation to enhance the penetration of invasive physiology-based therapy was to adopt the 5E approach: Evidence, Education, Expand hardware, Economics and Expert consensus. CONCLUSIONS: This consensus document and recommendations support interventional fellows and cardiologists, hospital administrators, patients, and medical device companies to build confidence and encourage wider implementation of invasive coronary physiology-guided therapy in the APAC region.
BACKGROUND: Currently, invasive physiologic assessment such as fractional flow reserve is widely used worldwide with different adoption rates around the globe. Patient characteristics and physician preferences often differ in the Asia-Pacific (APAC) region with respect to treatment strategy, techniques, lesion complexity, access to coronary physiology and imaging devices, as well as patient management. Thus, there is a need to construct a consensus document on recommendations for use of physiology-guided percutaneous coronary intervention (PCI) in APAC populations. This document serves as an overview of recommendations describing the best practices for APAC populations to achieve more consistent and optimal clinical outcomes. METHODS AND RESULTS: A comprehensive multiple-choice questionnaire was provided to 20 interven- tional cardiologists from 10 countries in the APAC region. Clinical evidence, tips and techniques, and clinical situations for the use of physiology-guided PCI in APAC were reviewed and used to propose key recommendations. There are suggestions to continue to develop evidence for lesion and patient types that will benefit from physiology, develop directions for future research in health economics and local data, develop appropriate use criteria in different countries, and emphasize the importance of education of all stakeholders. A consensus recommendation to enhance the penetration of invasive physiology-based therapy was to adopt the 5E approach: Evidence, Education, Expand hardware, Economics and Expert consensus. CONCLUSIONS: This consensus document and recommendations support interventional fellows and cardiologists, hospital administrators, patients, and medical device companies to build confidence and encourage wider implementation of invasive coronary physiology-guided therapy in the APAC region.
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