Original title: Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions. Results of the International Survey on Interventional Strategy. Reference: Gabor G. Toth et al. CircCardiovascInterv. 2014. Epubahead of print.
Measurement of fractional flow reserve (FFR) is recommended by the guidelines and supported by evidence in intermediate lesions when not any proof of ischemia is available by noninvasive testing. The International Survey on Interventional Strategy evaluated the preferred approach of 495 experienced Interventional Cardiologists from several centers around the world who gave their opinion on a total of 4421 injuries. In the case of intermediate lesions by visual estimation they had the choice to define the strategy using the following; quantitative angiography, intravascular ultrasound (IVUS), optical coherence tomography (OCT) and fractional flow reserve (FFR). In 3158 lesions (71%), the decision was made relying merely on the angiographic appearance that in other hand was discordant in 47% with the measurement of FFR.
FFR or other imaging modalities were required at 21% and 8% respectively. When comparing the 4 groups of participants according to their experience in FFR, it was observed that decisions based exclusively on angiography were less frequent as the FFR experience increased (77% versus 72% versus 69% versus 67%, respectively; p <0.001). As a result, the FFR was used more frequently (14% versus 19% versus 24% versus 28%, respectively; p <0.001) and the number of discordant decisions decreased (51% versus 49% versus 47% versus 43%, respectively; p <0.022).
Conclusion
These findings confirm that the visual estimation continues ruling the decision making in intermediate lesions indicating a worrying disengage between evidence, guidelines, and daily practice.
Editorial comment
Cost seems the simplest explanation that arises from the difference of what should be done and what is done in practice. Yet, all these interventionists had the possibility to select any of the methods available and they did not because they simply relied on angiography.
SOLACI
