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Intracoronary Imaging and Physiology to Guide PCI: Are We Ready for a Class I Guideline Recommendation?

  • Public Health Policy (SS Virani and D Mahtta, Section Editors)
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Abstract

Purpose of Review

Over the last decade, there has been a plethora of evidence to support the utilization of intravascular coronary imaging and physiological assessment to guide percutaneous coronary interventions (PCI). While there is a class I recommendation for the use of coronary physiology to guide PCI, the use of intravascular coronary imaging remains a class IIa recommendation. Herein, we aimed to review the recent scientific evidence from major trials highlighting the consideration for a future class I guideline recommendation for the use of intracoronary imaging.

Recent Findings

The benefits of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to guide and optimize PCI have been demonstrated in several large trials. These trials have demonstrated that IVUS reduces major adverse cardiovascular events. Similarly, intracoronary physiology has been demonstrated to be an important tool to guide revascularization decision-making and been associated with a lower incidence of death, non-fatal myocardial infarction, and repeat revascularization compared with angiography alone.

Summary

With existing clinical outcomes data on the benefit of intracoronary physiology and imaging-guided PCI as well as forthcoming data from ongoing trials regarding the use of these modalities, the interventional cardiology community is bound to transition from routine PCI to precision-, image-, and physiology-guided PCI.

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Authors and Affiliations

  1. Division of Interventional Cardiology, University of California, San Francisco, USA

    Lina Ya’Qoub, Krishan Soni, Jeffrey Zimmet, Joseph Yang & Kendrick Shunk

  2. Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA

    Mir B. Basir

  3. Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA

    Islam Y. Elgendy

  4. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Dhruv Mahtta

  5. Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Dhruv Mahtta

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  1. Lina Ya’Qoub
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Conflict of Interest

Mir B Basir reports personal fees from Abiomed, Boston Scientific, Saranas, and Zoll. Krishan Soni reports consulting fees from Qessential Medical Research (to him), payment for UCSF CME Course (to them from UCSF), speakers honorarium from Providence Health (to them); payment for expert testimony from Robert Durian LLC (to them). Kendrick Shunk reports grants or contracts from: Cardiovascular Systems Inc. (ECLIPSE trial) (to their institution), Boston Scientific (AGENT trial) (to their institution), and Siemens Medical Systems (to their institution); Royalties for TEMRI from Johns Hopkins; and consulting fees from PercAssist and TransAortic Medical. They also report participation on a Data Safety Monitoring Board or Advisory Board for DSMB, Syntactx; Medical monitor: TransAortic Medical FIM; Medical monitor: ENGULF trial. They also report Chair, CathPCI Steering Committee (ACC); and Options, PercAssist. The other authors declare that they have no conflict of interest.

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Ya’Qoub, L., Basir, M.B., Soni, K. et al. Intracoronary Imaging and Physiology to Guide PCI: Are We Ready for a Class I Guideline Recommendation?. Curr Cardiol Rep 25, 725–734 (2023). https://doi.org/10.1007/s11886-023-01896-5

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  • DOI: https://doi.org/10.1007/s11886-023-01896-5

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