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Updated: Aug 25, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Impact of intracoronary assessments on revascularization decisions: A contemporary evaluation
Taylor Gillmore1,2, Richard G Jung1,2,3,4, Robert Moreland1
1CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Intracoronary assessment (ICA) techniques altered management for coronary artery disease (CAD) in about a third of patients, often leading to fewer interventions without increasing adverse events. This real-world data supports ICA
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary angiography, while standard for diagnosing stenosis and guiding percutaneous coronary intervention (PCI), is limited by 2D imaging.
- Intracoronary assessment (ICA) techniques, including intravascular ultrasound, optical coherence tomography, and fractional flow reserve, offer 3D imaging and physiologic data.
- These advanced techniques may enhance PCI outcomes by influencing physician behavior.
Purpose of the Study:
- To evaluate the real-world application of ICA in managing coronary artery disease (CAD).
- To determine the impact of ICA on clinical decision-making for stenotic vessels.
- To assess the clinical outcomes following ICA-guided management changes.
Main Methods:
- A retrospective study included 1135 patients who underwent ICA between August 2015 and March 2020.
- Physiologic assessment (PA) and image assessment (IA) were the primary ICA modalities used.
- The study analyzed changes in physician management decisions and subsequent clinical outcomes.
Main Results:
- Management plans were altered in 38.1% of patients receiving PA and 23.9% of those receiving IA.
- Over half of these management changes involved decisions to defer intervention on stenotic vessels.
- One-year follow-up showed no significant increase in major adverse cardiac events or unplanned revascularization in patients with altered management.
Conclusions:
- Intracoronary assessment significantly influences physician management of CAD, typically resulting in fewer interventions.
- While not statistically significant, overall mortality was numerically lower in patients whose management was altered by ICA.
- The study suggests that relying on PA/IA data for management decisions does not increase patient risk at one year.
Objectives:
To investigate the real-world implementation of intracoronary assessment (ICA) techniques and evaluate their impact on clinical decisions regarding the management of coronary artery disease (CAD) in contemporary practice.
Background:
Coronary angiogram is the gold standard used to diagnose vessel stenosis and guide percutaneous coronary intervention (PCI); however, it is limited by its two-dimensional imaging capabilities. ICA techniques like intravascular ultrasound and optical coherence tomography capture the vessel in three-dimensional images. Comparatively, fractional flow reserve provides information on the physiologic significance of coronary stenosis. Both techniques may improve PCI outcomes if they routinely change physician behavior.
Methods:
Patients who underwent ICA between August 2015 and March 2020 were included in the study. The primary outcome was the clinical impact of ICA on physician clinical decision making of a stenotic vessel. The secondary outcome was the clinical changes that occurred following ICA.
Results:
A total of 1135 patients were included in the study. Physiologic assessment (PA) and image assessment (IA) were performed in 61.4% and 38.6% respectively. Management plans were changed in 38.1% and 23.9% of patients who received PA and IA. Over half of the management change resulted in physicians deciding to not intervene on the stenotic vessel. One-year outcome of these decisions showed no significant increase in major adverse cardiac events (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.40-1.15; p = 0.15) or unplanned revascularization (HR, 0.78; 95% CI, 0.35-1.74; p = 0.55) suggesting reliance on PA/IA data did not increase risk.
Conclusion:
Selected ICA alters physician management of CAD in one-third of patients being evaluated for revascularization-typically leading to fewer interventions. All cause death is numerally lower in patients that received a change in management. However, the 1-year outcome of these altered decisions does not appear to be significantly different.
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