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Curso de Atualização em Medicina Cardiovascular 2019
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Prevalence and determinants of use of invasive physiologic assessment: analysis of large cohort of 40.823 procedures over a 12-year period
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Mariana Gonçalves
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.1 Invasive Imaging and Functional Assessment
Session Type:
Comunicações Orais
FP Number:
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Authors:
Mariana Gonçalves; David Cabrita Roque; Luís Raposo ; Sérgio Bravo Baptista; Sérgio Madeira; Paulo Leal; Sílvio Leal; Miguel Santos; João Brito; Pedro Magno; Pedro de Araújo Gonçalves; Rui Campante Teles; Pedro Farto e Abreu; Manuel Almeida; Joao Morais; Miguel Mendes
Abstract
<p><strong>Background and Aim</strong></p> <p>The actual use of invasive physiology for risk stratification and guiding treatment decisions in patients undergoing coronary angiography remains largely unknown in the real world. We aimed to describe the prevalence of invasive physiological assessment, its pattern of use and main determinants, in a non-selected population of patients in daily practice.</p> <p> </p> <p><strong>Methods</strong></p> <p>Patient and procedural characteristics were collected using a dedicated electronic database. Overall, 40823 procedures performed between 2007 and 2018 were included (42% PCI and 58% diagnostic only). Physiology assessment was considered <em>per-procedure</em>.</p> <p> </p> <p><strong>Results</strong></p> <p>Over the entire study period, the overall use of physiology was 4.1% (N=1670). According to important landmarks (publication of major clinical trials) the prevalence was 1.3% until 2009, 4.7% between 2010 and 2017 (after FAME-1) and after 2017 (following release of iFR trials) it was 5.3% (p<.001). The proportion of procedures in which physiology was used, according to the clinical setting, was 6.1% for stable CAD, 2.9% of pts sustaining an ongoing Non-ST ACS, 1.6% of pts with a recent ACS (mostly non-culprit lesions after STEMI), 0.6% in pts with underlying valve disease and 1.6% in other miscellaneous indications.</p> <p>Overall, patients in whom invasive indexes were used were younger, more likely to be man, with higher prevalence of cardiovascular risk factors and a higher CVD burden. Although CAD extent (N diseased segments 2.1 vs 1.6; p<.001) was greater in those who had invasive interrogations, the association between CAD extent and performance of physiology was inconsistent.</p> <p>Among stable CAD patients who finally underwent PCI, FFR/iFR was used in only 6.8% of those with absent non-invasive information (either anatomical or functional). Conversely, in 26% of stable patients ultimately submitted to PCI there was no objective non-invasive evidence of ischemia nor was physiology performed.</p> <p>Interestingly, younger operators were more likely to use physiology (5.4% vs 2.0% vs 0.7% for age <40, 40-55 and >50 y.o., respectively; p<.001) and cases starting >6PM were less likely to include invasive measurements (2.9% vs 4.4%).</p> <p> </p> <p><strong>Conclusions</strong></p> <p>This large registry clearly indicates that the use of invasive physiologic assessment is very low in routine daily practice. Strategies are warranted to increase the awareness of the advantages of its integration into patient management algorithms and the implementation of current recommendations.</p>
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