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Updated: Jan 31, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Comprehensive Diagnosis of Myocardial Ischemia of Obstructive and Nonobstructive Origin With a Wire-Free Diagnostic
Marco Lombardi1,2, Adrian Jeronimo1, Akram Lahrifa1
1Hospital Clínico San Carlos, IdISSC, and CIBERCV, Complutense University of Madrid, Spain (M.L., A.J., A.L., L.P., G.N., J.C.D.-P., A.T., P.J.-Q., F.M.-T., G.T.C., L.N.-F., P.S., A.I.F.-O., H.M.-R., N.G., J.E.).
Insights
A new wire-free diagnostic strategy significantly increases the identification of myocardial ischemia causes in chronic coronary syndrome patients. This approach shows high agreement with wire-based methods and impacts treatment decisions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Current guidelines advocate for assessing obstructive and nonobstructive causes of myocardial ischemia in chronic coronary syndrome (CCS).
- Wire-based physiological assessment is effective but underutilized in clinical practice.
- An evaluation of a novel wire-free diagnostic approach was performed.
Purpose of the Study:
- To assess the diagnostic yield and clinical impact of a wire-free advanced invasive diagnosis (AID) strategy.
- To compare the wire-free AID strategy with traditional coronary angiography and wire-based methods.
- To determine the effectiveness of the wire-free AID strategy in guiding therapeutic decisions for CCS patients.
Main Methods:
- Subanalysis of the prospective, multicenter AID-ANGIO study.
- Inclusion of 262 patients with chronic coronary syndrome undergoing coronary angiography.
- The wire-free AID strategy integrated quantitative flow ratio, contrast angiography-derived index of coronary microcirculatory resistance, and acetylcholine testing.
Main Results:
- The wire-free AID strategy identified a cause of myocardial ischemia in 84.3% of patients, a twofold increase compared to coronary angiography alone (P<0.0001).
- Substantial agreement was observed between the wire-free and wire-based AID strategies (Cohen κ = 0.78).
- Therapeutic plans changed in 55.3% of patients following the wire-free AID strategy, with good concordance to wire-based findings.
Conclusions:
- The wire-free AID strategy offers significant clinical utility for patients with chronic coronary syndrome.
- This approach enhances diagnostic yield and improves clinical decision-making compared to coronary angiography alone.
- The wire-free method demonstrates substantial agreement with established wire-based assessments.
Background:
Current clinical guidelines recommend considering both obstructive and nonobstructive causes of myocardial ischemia in patients with chronic coronary syndrome. Wire-based physiological assessment constitutes a valid approach for this purpose, but it remains underutilized. We evaluated the diagnostic yield and clinical impact of an alternative wire-free approach for this purpose.
Methods:
This is a subanalysis of the multicenter, prospective AID-ANGIO study (Advanced Invasive Diagnosis for Patients with Chronic Coronary Syndromes Undergoing Coronary Angiography), evaluating the impact of a wire-free advanced invasive diagnosis (AID) strategy in the diagnostic workflow of patients with chronic coronary syndrome admitted to the catheterization laboratory. The wire-free AID strategy combined quantitative flow ratio for epicardial evaluation, contrast angiography-derived index of coronary microcirculatory resistance for microvascular assessment, and acetylcholine testing for the endothelial-dependent coronary function.
Results:
The study included 262 patients. The wire-free AID strategy identified a cause of myocardial ischemia in 84.3% of patients, representing a 2-fold increase in the identification of a cause of myocardial ischemia, compared with coronary angiography alone (P<0.0001). In addition, the wire-free AID strategy demonstrated substantial agreement compared with the wire-based AID strategy (Cohen κ 0.78). The wire-free AID strategy led to a change in the initial therapeutic plan in 55.3% of patients compared with coronary angiography. Nevertheless, the wire-free AID strategy maintained good concordance with the wire-based AID strategy (16.8% of therapeutic changes).
Conclusions:
This study supports the clinical utility of a wire-free AID strategy in patients with chronic coronary syndrome, demonstrating its potential to improve diagnostic yield and guide clinical decision-making compared with coronary angiography alone. In addition, it shows substantial agreement with the wire-based approach.
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