title: Revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy.
abstract: BACKGROUND
  Fractional flow reserve (FFR) measurement of intermediate coronary stenoses is recommended by guidelines when demonstration of ischemia by noninvasive testing is unavailable. The study aims to evaluate the penetration of this recommendation into current thinking about revascularization strategies for stable coronary artery disease.
  
  
  RESULTS
  International Survey on Interventional Strategy was conducted via a web-based platform. First, participants' experiences in interventional cardiology were queried. Second, 5 complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography values were known; however, remained undisclosed. Determination of stenosis significance was asked for each lesion. In cases of uncertainty, the most appropriate adjunctive invasive diagnostic method among quantitative coronary angiography, intravascular ultrasound, optical coherence tomography, or FFR needed to be selected. International Survey on Interventional Strategy was taken by 495 participants who provided 4421 lesion evaluations. In 3158 (71%) decisions, participants relied solely on angiographic appearance that was discordant in 47% with the known FFR, using 0.80 as cutoff value. The use of FFR and imaging modalities was requested in 21% and 8%, respectively. Comparing 4 groups of participants according to the experience in FFR, angiogram-based decisions were less frequent with increasing experience (77% versus 72% versus 69% versus 67%, respectively; P<0.001). As a result, requests for FFR were more frequent (14% versus 19% versus 24% versus 28%, respectively; P<0.001) and rates of discordant decisions decreased (51% versus 49% versus 47% versus 43%, respectively; P<0.022).
  
  
  CONCLUSIONS
  The findings confirm that, even when all potential external constraints are virtually eliminated, visual estimation continues to dominate the treatment decisions for intermediate stenoses, indicative of a worrisome disconnect between recommendations and current practice.
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Toth
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Balint
authors.initials: B
authors.lastname: Toth
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Nils P
authors.initials: NP
authors.lastname: Johnson
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Frederic
authors.initials: F
authors.lastname: De Vroey
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Serafino
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Stylianos
authors.initials: S
authors.lastname: Pyxaras
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Mariano
authors.initials: M
authors.lastname: Pellicano
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Carlos
authors.initials: C
authors.lastname: Van Mieghem
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Guy R
authors.initials: GR
authors.lastname: Heyndrickx
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.).
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.). william.wijns@olvz-aalst.be.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
mesh_terms: D000328:Adult; D060050:Angina, Stable / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000379:methods / Q000592:standards; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: cardiac catheterization; coronary angiography; ischemic heart disease; stents; ultrasound, Doppler