A groundbreaking study, the AID-ANGIO, has revolutionised the diagnostic approach to chronic coronary syndromes (CCS), shedding light on obstructive and non-obstructive mechanisms of ischemia. The findings were presented by Adrián Jerónimo, Hospital Clínico San Carlos IdISSC, Universidad Complutense de Madrid, Spain, at the latest 2024 EuroPCR press conference.
Conducted across four Spanish centres, this prospective, multicentre study enrolled a consecutive all-comers population of CCS patients referred for invasive coronary angiography (ICA). The study introduced a hierarchical strategy known as Advanced Invasive Diagnosis (AID), incorporating various components to enhance diagnostic accuracy. These components include ICA for visually diagnosing major blockages, Fractional Flow Reserve/Resting Full-cycle Ratio (FFR/RFR) to assess lesser stenoses, Coronary Flow Reserve/Index of Microcirculatory Resistance (CFR/IMR) to evaluate endothelium-independent impairment, and the Acetylcholine (Ach) test to analyse endothelium-dependent impairment. Technical aspects involved PressurewireX, Coroventis console, bolus thermodilution, and intravenous adenosine-based hyperaemia.
Key findings from the study underscored the significant impact of the AID strategy on therapeutic decision-making. Notably, nearly 60% of treatment plans were modified based on AID information, highlighting its role in optimising patient care. Additionally, the study revealed a high prevalence of INOCA (Ischemia with No Obstructive Coronary Artery Disease) in CCS patients, emphasising the importance of accurate diagnosis beyond ICA and clinical data.
The adoption of the AID strategy is further facilitated by its alignment with European and American clinical practice guidelines. Healthcare professionals can now leverage this comprehensive approach to identify actionable causes of myocardial ischemia in over 80% of CCS patients, marking a significant advancement in the field of cardiovascular medicine.
Reference:
Adrián Jerónimo et al. Combining angiography and pre-specified intracoronary testing in patients with chronic coronary syndromes: the AID-ANGIO study. EuroPCR 14.05.2024.
