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After ISCHEMIA: is invasive physiology the only remaining gatekeeper for myocardial revascularization in chronic coronary syndromes?

Nach der ISCHEMIA-Studie – ist die invasive physiologische Untersuchung der letzte verbliebene Türöffner zur Myokardrevaskularisation beim chronischen Koronarsyndrom?

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Abstract

The International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) has the potential to be a game changer in terms of the diagnostic and management approach to patients presenting with chronic coronary syndrome, suggesting that coronary revascularization may become almost like a “bail-out” strategy in the treatment of these patients. However, invasive perfusion assessment as a means of detecting the source of myocardial ischaemia at a lesion level, such as fractional flow reserve (FFR), has been validated in the past and established beyond doubt as a key diagnostic tool. The complementary role of the two approaches will be discussed here.

Zusammenfassung

Die International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA)-Studie könnte von bahnbrechender Bedeutung für das diagnostische und therapeutische Vorgehen bei Patienten mit chronischem Koronarsyndrom sein. Sie deutet an, dass die koronare Revaskularisation zu einer Art „Rettungsmaßnahme” in der Behandlung dieser Patienten werden könnte. Allerdings ist die invasive Perfusionsuntersuchung, beispielsweise durch Bestimmung der fraktionellen Flussreserve (FFR), als Mittel zum Aufspüren des Ursprungs der Myokardischämie auf Läsionsebene validiert und als diagnostisches Schlüsselinstrument unbestritten etabliert. Im vorliegenden Beitrag wird die komplementäre Funktion der beiden Ansätze diskutiert.

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Authors and Affiliations

  1. Royal Devon & Exeter NHS Foundation Trust, Barrack Rd, Exeter, EX2 5DW, Devon, UK

    Sadeek Kanoun MBBCh, MRCP (UK)

  2. University Heart Center Graz, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    Gabor G. Toth MD, PhD, FESC

Authors
  1. Sadeek Kanoun MBBCh, MRCP (UK)
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  2. Gabor G. Toth MD, PhD, FESC
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Correspondence to Gabor G. Toth MD, PhD, FESC.

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Conflict of interest

S. Kanoun declares that he has no competing interests. G.G. Toth receives consultancy fees and unrestricted research grants from Biotronik, Medtronic, Boston Scientific and Abbott.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Kanoun, S., Toth, G.G. After ISCHEMIA: is invasive physiology the only remaining gatekeeper for myocardial revascularization in chronic coronary syndromes?. Herz 45, 453–457 (2020). https://doi.org/10.1007/s00059-020-04945-9

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  • DOI: https://doi.org/10.1007/s00059-020-04945-9

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