Routine Pressure Wire Assessment at Time of Diagnostic Angiography
Is It Ready for Prime Time?
To define the most appropriate therapeutical management plan in patients suspected of having coronary artery disease is becoming the ultimate goal in this population. Accumulated evidence suggests that our current practice has major flaws. The use of a noninvasive test as the key information to plan a coronary angiography can be questioned. Patel et al1 indeed demonstrated that the performance of such noninvasive test before angiographic evaluation provides little added value to the usual clinical parameters to predict the presence of coronary artery disease. The results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study suggest also that our current approach of deciding on revascularization based on the angiographic severity of coronary artery disease does not allow us to identify a population in which revascularization will provide a substantial clinical benefit.2 These recent observations have created much confusion among physicians and have increased their difficulties to decide on the most appropriate management plan to choose the best treatment for their patients.3 The implementation of the appropriate use criteria approach for coronary revascularization is an attempt to provide such guidance for the physician.4 Although meritorious, this approach is largely based on consensus of experts and could be seen by some physicians as relatively complex. In addition, the key objective of the appropriate use criteria approach is more to avoid a gross misuse of revascularization than to provide a refined decision tailored for each patient. Considering all these issues, there is a critical need of a better approach to decide on the most appropriate treatment option for each patient.
Article see p 248
The elegant RIPCORD (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain) study by Curzen al5 in this issue of Circulation: Cardiovascular Interventions, …