Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
Rev Port Cardiol (Engl Ed). 2021 Oct;40(10):771-781. doi: 10.1016/j.repce.2021.10.008.
Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame.
We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed.
Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology.
Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.
在患有冠状动脉疾病的患者中，侵入性生理评估的使用差异很大，并且被认为很低。我们旨在检查在很长一段时间内，在接受侵入性冠状动脉造影的未选择人群中，采用率以及使用模式和决定因素。
我们回顾性地确定了 2007 年至 2018 年期间在两个大容量中心进行的 40821 例冠状动脉病例中每个程序的生理评估患病率。根据程序类型和患者及操作人员相关变量检查采用情况。还评估了其与相关科学里程碑（例如临床试验结果和实践指南的发布）的相关性。
总体采用率较低，从因潜在瓣膜疾病而接受侵入性冠状动脉造影的患者的 0.6％到稳定型冠状动脉疾病（CAD）患者的 6％；在急性冠状动脉综合征患者中为 3.1％。在科学里程碑中，FAME 1、FAME 2 的长期结果和 2014 年欧洲心肌血运重建指南与实践的变化相关。瞬时无波比（iFR）试验的发表对采用率没有影响，除了 iFR 使用率较高。在接受经皮冠状动脉介入治疗的 42.9％稳定型 CAD 患者中，没有客观的非缺血性证据，也没有进行生理评估。操作人员年龄较轻（<40 岁、40-55 岁和>55 岁的患者分别为 4.5％、4.0％和 0.9％；p<0.001）和白天手术时间较晚（下午 6 点至 8 点之间为 2.9％，其他时间为 4.4％）是采用侵入性生理学的独立相关因素。
我们的研究证实了常规实践中侵入性生理学的低使用率。静息指数的可用性并未增加采用率。需要制定策略来促进指南的实施，并改善患者的护理和临床结果。
