Contemporary coronary physiology practice: An international survey of interventional cardiologists

Modern coronary physiology in the cardiac catheterization laboratory has evolved from a solely wire-based approach to a broader portfolio that now includes coronary computed tomography angiography, angiography-derived physiology, and microcatheter-derived physiology. Limited data exists on real-world practice patterns and perspectives among interventional cardiologists.

A web-based 76-item international survey was distributed to attending interventional cardiologists via email and social media from April to July 2024.

In total, 206 interventional cardiologists completed the survey. Respondents represented diverse global regions, with 55% based in the United States. Most operators performed both percutaneous coronary intervention (PCI) and structural interventions (34%) or only PCI (25%). Nearly all respondents (98%) had access to invasive coronary physiology tools, with non-hyperemic pressure ratios (NHPR) usage being favored over fractional flow reserve (FFR) by operators (60% vs. 40%), particularly in US centers. Pressure-wire pullback was routinely performed by 44% of operators. Angiography-derived FFR was used by 33%, with lack of access being the primary barrier to adoption. Coronary microvascular dysfunction (CMD) evaluation was performed or referred by 39%, primarily using bolus thermodilution (78%) followed by continuous thermodilution in 22%.

This multinational survey demonstrates substantial heterogeneity and marked geographic variation in the use of modern coronary physiology tools. Although important advances have broadened the coronary physiology toolkit, their routine use remains limited and inconsistent. These findings provide valuable insights into how novel modalities are being integrated into practice, including notable geographic differences.