Visual Assessment Favored by Many Over Invasive Coronary Physiology Assessment of ACS

Use of coronary physiology assessment in daily practice in catheterization laboratories met current guideline recommendations in only 48 percent of cases, with operator confidence in visual assessment being the most frequent reason for not using the physiology guidance, according to results from the ERIS study presented on May 23 at EuroPCR in Paris and published in JACC: Cardiovascular Interventions.

In the investigator-driven, prospective, cross-sectional study, Matteo Tebaldi, MD, et al., reviewed cases at 76 Italian catheterization laboratories. Each center included consecutive cases for which the operators either did use fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) assessment (physiology assessment group; n=1,177) or did not use it although patients met the inclusion and exclusion criteria (visual estimation group; n=681).

Overall, 140 operators provided 1,400 decisions about stenosis significance. Of these, 52 percent were based on visual assessment only and these decisions were consistent with the intracoronary pressure measurement in 46 percent of cases. In the other 48 percent of cases, operators acknowledged the need for an additional diagnostic tool, mostly intracoronary pressure measurement. 

According to the authors, this is the first study to collect operators’ rationale for not performing the physiology assessment at the time of the clinical decision-making process in real-life cases.

In an accompanying editorial comment, Nils P. Johnson, MD, FACC, et al., write that this study helps us to critically evaluate potential responses to the question “‘Why don't interventional cardiologists use coronary physiology?’… Although operators can be reluctant to admit it, the fundamental reason has received different labels: attitude, belief, local practice, ‘experience’ and culture. Put simply, we as a profession do not yet emotionally accept coronary physiology to guide treatment.”

Keywords: Constriction, Pathologic, Research Personnel, Cross-Sectional Studies, Prospective Studies, Mental Processes, Catheterization

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