CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Catheter Cardiovasc Interv. 2022 Nov;100(6):955-963. doi: 10.1002/ccd.30417. Epub 2022 Oct 19.
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.
研究冠状动脉内评估（ICA）技术的实际应用，并评估其对当代临床实践中冠状动脉疾病（CAD）管理的临床决策的影响。
冠状动脉造影是诊断血管狭窄和指导经皮冠状动脉介入治疗（PCI）的金标准；然而，它受到二维成像能力的限制。血管内超声和光学相干断层扫描等 ICA 技术可以捕获三维血管图像。相比之下，血流储备分数提供了关于冠状动脉狭窄的生理意义的信息。如果这些技术能常规改变医生的行为，两种技术都可能改善 PCI 结果。
研究纳入了 2015 年 8 月至 2020 年 3 月期间接受 ICA 的患者。主要结局是 ICA 对医生对狭窄血管的临床决策的临床影响。次要结局是 ICA 后发生的临床变化。
共有 1135 例患者纳入研究。分别有 61.4%和 38.6%的患者进行了生理评估（PA）和影像评估（IA）。接受 PA 和 IA 的患者中，有 38.1%和 23.9%的患者的治疗方案发生了改变。超过一半的治疗方案改变导致医生决定不干预狭窄血管。这些决策的一年结果显示，主要不良心脏事件（危险比[HR]，0.68；95%置信区间[CI]，0.40-1.15；p=0.15）或计划外血运重建（HR，0.78；95%CI，0.35-1.74；p=0.55）没有显著增加，这表明依赖 PA/IA 数据不会增加风险。
选择性 ICA 改变了三分之一接受血管重建评估的 CAD 患者的医生治疗方案，通常会减少干预。接受治疗方案改变的患者的全因死亡率略低。然而，这些改变决策的一年结果似乎没有显著差异。
