Jerónimo Adrián, Paredes-Vázquez José G, Travieso Alejandro, Shabbir Asad, Jiménez-Quevedo Pilar, Macaya-Ten Fernando, Nombela-Franco Luis, Núñez-Gil Iván J, Salinas Pablo, Gómez-Polo Juan Carlos, García-Arribas Daniel, Vilacosta Isidre, Pérez-Velasco Javier García, García-Romo Eva, García-Lledó Alberto, Grande-Ingelmo Juan Manuel, Fernández-Rozas Inmaculada, Alonso-Belló Javier, Curcio Alejandro, Fernández-Ortiz Antonio I, Villacastín Julián P, Mejía-Rentería Hernán, Gonzalo Nieves, Escaned Javier
Department of Cardiology, Hospital Clínico San Carlos IDISSC, CIBER-CV, Madrid, Spain and Universidad Complutense de Madrid, Madrid, Spain.
Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
EuroIntervention. 2025 Jan 6;21(1):35-45. doi: 10.4244/EIJ-D-24-00499.
The diagnostic yield of invasive coronary angiography (ICA) in patients with chronic coronary syndromes (CCS) in contemporary practice is uncertain.
We investigated the value of an advanced invasive diagnosis (AID) strategy combining angiography and intracoronary testing.
AID-ANGIO is an all-comers, prospective, multicentre study enrolling CCS patients referred for ICA. Obstructive coronary artery disease (CAD) was investigated with angiography and pressure guidewires. In the absence of obstructive CAD, intracoronary testing for ischaemia with non-obstructive coronary arteries (INOCA) was performed. The primary endpoint was the proportion of patients with a cause of ischaemia identified by the AID strategy. To assess the effect of AID on decision-making, an initial therapeutic plan was first prepared by clinical cardiologists based on ICA and medical information. Subsequently, based on AID data, a final therapeutic plan was drafted by clinical and interventional cardiologists (Ischaemia Team).
We enrolled 317 patients (44.2% female). Based on ICA, obstructive CAD was diagnosed in 32.2% of patients. With the AID strategy, a cause of myocardial ischaemia was identified in 84.2% (p<0.001): obstructive CAD in 39.1% and INOCA in 45.1%. Only 15.8% of patients did not show any abnormalities. Modification of the original treatment plan with the AID strategy occurred in 59.9% of cases.
In assessing ischaemia-generating coronary abnormalities, prespecified use of the AID strategy was associated with a 2.6-fold increase in diagnostic yield compared with ICA (84.2% vs 32.2%, respectively), largely due to the identification of INOCA. Modification of the therapeutic plan with the AID strategy occurred in 59.9% of cases. (ClinicalTrials.gov: NCT05635994).
在当代临床实践中，慢性冠状动脉综合征（CCS）患者进行有创冠状动脉造影（ICA）的诊断价值尚不确定。
我们研究了一种将血管造影和冠状动脉内检测相结合的高级有创诊断（AID）策略的价值。
AID-ANGIO是一项纳入所有CCS患者并转介进行ICA的前瞻性多中心研究。采用血管造影和压力导丝研究阻塞性冠状动脉疾病（CAD）。在无阻塞性CAD的情况下，对非阻塞性冠状动脉（INOCA）进行冠状动脉内缺血检测。主要终点是通过AID策略确定的缺血原因患者的比例。为了评估AID对决策的影响，临床心脏病专家首先根据ICA和医学信息制定初始治疗方案。随后，根据AID数据，由临床和介入心脏病专家（缺血团队）起草最终治疗方案。
我们纳入了317例患者（44.2%为女性）。基于ICA，32.2%的患者被诊断为阻塞性CAD。采用AID策略，84.2%的患者确定了心肌缺血原因（p<0.001）：阻塞性CAD占39.1%，INOCA占45.1%。仅15.8%的患者未显示任何异常。采用AID策略对原治疗方案进行修改的病例占59.9%。
在评估产生缺血的冠状动脉异常时，与ICA相比，预先指定使用AID策略使诊断率提高了2.6倍（分别为84.2%和32.2%），这主要是由于INOCA的识别。采用AID策略对治疗方案进行修改的病例占59.9%。（ClinicalTrials.gov：NCT05635994）
