SCAI Outlines Best Uses for Intracoronary Diagnostic Tools

November 13, 2013—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of SCAI's recommendations for optimal use of three intracoronary diagnostic technologies used by interventional cardiologists to assess the severity of blockages in heart arteries.

The SCAI expert consensus document by Amir Lofti, MD, et al is available online on the society's website at www.scai.org and in Catheterization and Cardiovascular Interventions. The document's lead author is Lloyd W. Klein, MD, Professor of Medicine at Rush University Medical Center in Chicago, Illinois.

SCAI's guidance addresses fractional flow reserve (FFR), intravascular ultrasound (IVUS), and optical coherence tomography (OCT). The guidance for these three tools for improved patient care, particularly for patients whose heart disease is considered complex or whose disease levels are unclear from angiography, is intended to ensure that these technologies are applied in a manner most beneficial to patients.

In SCAI's announcement, Dr. Klein commented, “Physicians will find these recommendations helpful as they apply these techniques to help patients with more complex cases or who have tests that contradict one another. Many patients will not need these techniques in their care, but for those who will benefit from them, this guidance offers physicians the parameters to ensure they are put to use best.”

SCAI President Ted A. Bass, added, “SCAI is dedicated to providing interventional cardiologists with tools and guidance that improve the care and outcomes of our patients every day. These recommendations are the latest example of our ongoing efforts, clarifying when and in whom FFR, IVUS, and OCT work best.”

According to SCAI, the expert consensus document reviews each of the three technologies in terms of level of benefit to patients. This categorization offers physicians perspective on the best current uses of each test, where no proven benefit has been shown, and where there may be potential for benefit once more information is gathered over time.

The SCAI announcement outlined the following highlights from the document:

• In patients with complex heart disease, angioplasty with FFR measurement improves outcomes and saves resources when compared to angioplasty guided by angiography alone. Knowing the FFR measurement may help guide decisions on whether to perform angioplasty or open-heart bypass surgery and whether a patient needs urgent in-hospital care to open blocked arteries versus medication alone.

• IVUS helps to accurately determine how well a stent is placed in an artery, ensuring a proper fit based on the size of the artery. IVUS can be used with certain types of blockages to help determine whether a patient will need revascularization to open a blocked artery. The authors note that IVUS should not be used to determine the severity of certain types of heart disease.

• OCT is beneficial to determine how well a stent is placed, with improved imaging compared to IVUS, and can be useful in assessing changes in plaque that blocks the arteries.