SPC365

Penetrance of physiology use in invasive coronary angiography: A lesion-level evaluation

Session: Posters (Sessão 3 - Écran 8) - Intervenção coronária
Speaker: Sérgio Baptista

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.4 Coronary Artery Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Sérgio Bravo Baptista; Maria Teresa Barros; Miguel Santos; Pedro Magno; José Loureiro; Luís Brízida; Pedro Farto e Abreu; Carlos Morais

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt">Introduction</span></strong><span style="font-size:11.5pt">: The penetrance of pressure-wire invasive physiology (pPW) use has been traditionally evaluated by describing the number of physiology-guided procedures according to the total number of percutaneous coronary interventions (PCI) performed in each centre. This approach is very limited, since, on one hand, most PCIs (including culprit lesion&rsquo;s PCI in acute coronary syndromes) do not need to be guided by pressure-wires (PW) and, on the other hand, a significant number of PW evaluations results in deferral of revascularization. Our purpose was to evaluate physiology use at a lesion-level, namely what would be the maximal possible use of these procedures and the implications this would have in pPW reporting.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt">Population and Methods</span></strong><span style="font-size:11.5pt">: </span><span style="font-size:11.5pt">All consecutive patients (pts) who underwent coronary angiography in a single year were evaluated and all significant (&gt;50% lesions) were recorded. Treatment decisions were </span><span style="font-size:11.5pt">evaluated for each lesion according to the guideline-based indications (culprit lesions in ACS; lesions with proved ischemia non-invasive imaging tests; lesions &gt;90%; and, single lesions with a positive ischemia test). &nbsp;CTO&rsquo;s were excluded. The remaining intermediate lesions (50-90% non-culprit lesions without documented ischemia) were identified as the ones in which a physiology-guided decision could have been done.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.5pt">Results</span></strong><span style="font-size:11.5pt">: 545 pts were included, with a total of 1525 lesions, of which 557 were treated by PCI (413 procedures, in 349 pts). Of the initial 1525 lesions, 606 (39.7%) had a guideline-based indication for revascularization, 118 (7.7%) were CTOs, 90 (5.9%) were in small vessels or very distal and 56 (3.7%) were in vessels with a patent coronary bypass. The remaining 655 lesions (43.0% of all lesions, described in 306 pts), were considered the ones in which PW evaluation could have been performed. Accordingly, the maximal pPW would be 43.0% of all lesions (655/1525), 56.1% of all pts (306/545) and 74.1% of all PCIs (306/413). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="font-size:11.5pt">Importantly, if pts with multivessel disease and/or left main disease, who were sent for immediate surgical revascularization or heart team discussion are also excluded (84 pts, 345 lesions), maximal pPW in the remaining 461 pts/1180 lesions would be even lower:respectively 40.7% (480/1180), 53.1% (245/461) and 59.3% (245/413).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="font-size:11.5pt">A total of 53 PW evaluations were performed, in 43 pts. Using the above methodology, the actual pPW in the included population was 8.1% of all lesions with an indication for PW (53/655), 14.1% of all pts with an indication for PW (43/306) and 10.4% of all PCI procedures performed (43/413), respectively. If surgical and heart team pts are excluded, pPW is, respectively, 11.0%, 17.6% and 10.4%. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.5pt">Conclusions</span></strong><span style="font-size:11.5pt">: pPW use is overestimated when it is reported as a function of the number of PCIs performed, or the number of pts evaluated. Using a lesion-based evaluation, the maximal pPW use would be 40 to 43% of all lesions.</span></span></span></span></p>