Findings from a Feb. 26 comparative effectiveness review conducted by the Agency for Healthcare Research and Quality (AHRQ) show that intravascular diagnostic procedures and imagining techniques may be a better option than angiography alone for coronary artery stenting.

The treatment options for patients with coronary artery disease (CAD) are complex, and procedures that help guide decision making have expanded in recent years. Angiography has long been the standard technique but has its limitations. Due to these limitations, intravascular diagnostic procedures and imaging techniques that provide more comprehensive information on coronary stenosis have been developed to supplement angiography and enhance decision making.

Additional Resources AHRQ Comparative Effectiveness Review FAME 2 Trial Summary CardioSmart for Your Patients: CAD

The review examined a total of 37 studies from 42 articles to "assess whether the additional diagnostic information produced actually translates into benefits for patients that outweigh the risks." Data from "all comparative studies, including randomized controlled trials (RCTs) and nonrandomized comparative studies that provided data directly comparing intravascular diagnostic techniques and angiography with angiography alone, or studies comparing one intravascular diagnostic technique with another" were collected from a variety of sources, including the ACC, Transcatheter Cardiovascular Therapeutics, and the American Heart Association. Fractional flow reserve (FFR) and intravascular ultrasound (IVUS) were the key intravascular diagnostic techniques examined.

There was a moderate decrease in risk of death or myocardial infarction (MI), decrease in the cost of stenting and fewer implanted stents when the FFR technique was used as compared to angiography alone. However, the findings are limited because they were based on a single trial (FAME) and additional studies are required to confirm the conclusions. While IVUS was not found to impact mortality or MI rates, "there is a moderate strength of evidence that the use of IVUS to guide stent optimization reduces clinically-driven repeat revascularizations and restenosis" vs. angiography alone. The authors add that there are limitations to these findings as the majority of the IVUS trials were conducted more than a decade ago.

"Future work will also need to evaluate longer-term (on the order of years) patient outcomes to better appreciate the true impact of these techniques," the authors conclude.

Keywords: Coronary Artery Disease, Myocardial Infarction, Coronary Stenosis, Coronary Disease, Health Services Research, United States, Stents

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