Revascularization decisions in patients with chronic coronary syndromes: Results of the second International Survey on Interventional Strategy (ISIS-2)

Tóth, Gábor G.; Johnson, Nils P.; Wijns, William; Toth, Balint; Achim, Alexandru; Fournier, Stéphane; Barbato, Emanuele

doi:10.1016/j.ijcard.2021.05.005

Cited by 21 publications

(12 citation statements)

References 15 publications

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“…The measurement of TBI is important in this context because digital vessels rarely calcify and can provide an accurate assessment of vascular disease in the presence of calcification. As with coronary arteries [ 47 ], the peripheral fractional flow reserve can be measured invasively via stenosis with a pressure wire; although there have been several promising attempts, technical drawbacks, such as unknown cut-off values and unknown optimal papaverine/adenosine doses, have made this measurement unpopular in terms of peripheral vasculature [ 48 ].…”

Section: Diagnosismentioning

confidence: 99%

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

Achim

Stanek

Homorodean

et al. 2022

IJERPH

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Peripheral artery disease (PAD) increases the risk of diabetes, while diabetes increases the risk of PAD, and certain symptoms in each disease increase the risk of contracting the other. This review aims to shed light on this harmful interplay between the two disorders, with an emphasis on the phenotype of a patient with both diabetes and PAD, and whether treatment should be individualized in this high-risk population. In addition, current guideline recommendations for the treatment of PAD were analyzed, in an attempt to establish the differences and evidence gaps across a population suffering from these two interconnected disorders.

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Section: Diagnosismentioning

confidence: 99%

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

Achim

Stanek

Homorodean

et al. 2022

IJERPH

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“…Still, it is commonly agreed that CABG is the revascularization technique of choice in the setting of left main disease (LMD) or multivessel disease (MVD) when clinically viable. This derived on account of randomized controlled trials which compared revascularization strategies in MVD and found that CABG is associated with fewer repeat revascularization procedures and improved survival ( 1 , 2 ), even if PCI is performed using the latest generation drug-eluting stents and is guided by fractional flow reserve (FFR) ( 3 – 5 ). Nonetheless, in medical practice, physicians frequently encounter patients who would have been excluded from clinical trials because of significant medical comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Surgical Turned-Downed CHIP Cases—Can PCI Save the Day?

Achim

Marc

Ruzsa

2022

Front. Cardiovasc. Med.

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Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.

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“…As a result, decisions have remained based purely on angiography alone in more than 60% of cases. Of these, decisions were discordant with functional assessment in up to 40% of the cases, mainly resulting in overtreatment (i.e., PCI in spite of preserved FFR) 53 .…”

Section: Guidelinesmentioning

confidence: 99%

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

Fezzi¹,

Huang²,

Lunardi³

et al. 2022

AsiaIntervention

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Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.

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Revascularization decisions in patients with chronic coronary syndromes: Results of the second International Survey on Interventional Strategy (ISIS-2)

Cited by 21 publications

References 15 publications

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

Surgical Turned-Downed CHIP Cases—Can PCI Save the Day?

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

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