Gabor G Toth1, Nils P Johnson2, William Wijns3, Balint Toth1, Alexandru Achim1, Stephane Fournier4, Emanuele Barbato5. 1. University Heart Center Graz, Medical University of Graz, Graz, Austria. 2. Weatherhead PET Center, University of Texas Medical School and Memorial Hermann Hospital, Houston, USA. 3. The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, Galway, Ireland. Electronic address: william.wyns@gmail.com. 4. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 5. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Cardiovascular Research Center Aalst, OLV-Clinic Aalst, Aalst, Belgium.
Abstract
BACKGROUND: In chronic coronary syndromes, guidelines mandate invasive functional guidance of revascularization whenever non-invasive proof of ischemia is missing. ISIS-2 survey aimed to evaluate how the adoption of guideline recommendation on ischemia-guided revascularization has evolved over the last 5-7 years. METHODS: In ISIS-2 participants assessed five complete angiograms, presenting only intermediate stenoses without information on non-invasive pre-testing. Fractional flow reserve was known for each stenosis, but remained undisclosed. Participants could determine stenosis significance either by angiography or by requesting an adjunctive invasive diagnostic method (intravascular imaging or functional tests). Primary endpoint was the rate of requesting adjunctive functional assessment. Secondary endpoints were the rate of concordance between angiography-based decisions and know functional severity. ISIS-2 utilized the same web-based platform as ISIS-1 in 2013. (NCT04001452). RESULTS: 334 participants performed 2059 lesion evaluations: 1202 (59%) decisions were based solely on angiography without expressed need for further evaluation. These decisions were discordant with known functional significance in 39%, mainly with potential of overtreatment. Participants requested invasive functional assessment in 643 (31%) and intravascular imaging in 214 (10%) cases. Compared to ISIS-1 the rate of purely angiography-based decisions has decreased (59% vs 66%; p < 0.001), while invasive functional tests were more frequently requested (31% vs 25%; p < 0.001). CONCLUSIONS: ISIS-2 suggests an evolving pattern in the intention to integrate invasive coronary physiology into the revascularization decisions. However, the disconnect between recommendations and current thinking is still dominant.
BACKGROUND: In chronic coronary syndromes, guidelines mandate invasive functional guidance of revascularization whenever non-invasive proof of ischemia is missing. ISIS-2 survey aimed to evaluate how the adoption of guideline recommendation on ischemia-guided revascularization has evolved over the last 5-7 years. METHODS: In ISIS-2 participants assessed five complete angiograms, presenting only intermediate stenoses without information on non-invasive pre-testing. Fractional flow reserve was known for each stenosis, but remained undisclosed. Participants could determine stenosis significance either by angiography or by requesting an adjunctive invasive diagnostic method (intravascular imaging or functional tests). Primary endpoint was the rate of requesting adjunctive functional assessment. Secondary endpoints were the rate of concordance between angiography-based decisions and know functional severity. ISIS-2 utilized the same web-based platform as ISIS-1 in 2013. (NCT04001452). RESULTS: 334 participants performed 2059 lesion evaluations: 1202 (59%) decisions were based solely on angiography without expressed need for further evaluation. These decisions were discordant with known functional significance in 39%, mainly with potential of overtreatment. Participants requested invasive functional assessment in 643 (31%) and intravascular imaging in 214 (10%) cases. Compared to ISIS-1 the rate of purely angiography-based decisions has decreased (59% vs 66%; p < 0.001), while invasive functional tests were more frequently requested (31% vs 25%; p < 0.001). CONCLUSIONS: ISIS-2 suggests an evolving pattern in the intention to integrate invasive coronary physiology into the revascularization decisions. However, the disconnect between recommendations and current thinking is still dominant.
Authors: Alexandru Achim; Agata Stanek; Călin Homorodean; Mihail Spinu; Horea Laurenţiu Onea; Leontin Lazăr; Mădălin Marc; Zoltán Ruzsa; Dan Mircea Olinic Journal: Int J Environ Res Public Health Date: 2022-08-09 Impact factor: 4.614