Author + information
- Received March 1, 2018
- Revision received April 13, 2018
- Accepted April 26, 2018
- Published online May 23, 2018.
- Matteo Tebaldi, MDa,
- Simone Biscaglia, MDa,
- Massimo Fineschi, MDb,
- Giuseppe Musumeci, MDc,
- Alfredo Marchese, MDd,
- Antonio Maria Leone, MDe,
- Marco Luciano Rossi, MDf,
- Giulio Stefanini, MDf,
- Antongiulio Maione, MDg,
- Alberto Menozzi, MDh,
- Fabio Tarantino, MDi,
- Veronica Lodolini, BSca,
- Francesco Gallo, MDa,
- Emanuele Barbato, MD, PhDj,
- Giuseppe Tarantini, MD, PhDk and
- Gianluca Campo, MDa,l,∗ ()
- aCardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
- bDepartment of Cardiovascular Diseases, University Hospital Santa Maria alle Scotte, Siena, Italy
- cS.C. Cardiologia, A.O. Santa Croce e Carle, Cuneo, Italy
- dInterventional Cardiology Unit, Anthea Hospital, Bari, Italy
- eInstitute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
- fDivision of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
- gDepartment of Medicine and Surgery, University of Salerno, Salerno, Italy
- hUnità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria, Parma, Italy
- iCardiology Unit, Ospedale G.B. Morgagni, Forlì, Italy
- jDivision of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- kDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- lMaria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy
- ↵∗Address for correspondence:
Dr. Gianluca Campo, Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna, Via Aldo Moro 8, Cona (FE), 44124, Italy.
Objectives The aims of the ERIS (Evolving Routine Standards of FFR Use) study are to describe the current use of invasive coronary physiology assessment and discern the reasons for its nonuse in daily practice.
Background Adoption of coronary physiology guidance in the catheterization laboratory varies among countries, centers, and operators.
Methods ERIS is an investigator-driven, nationwide, prospective, cross-sectional study involving 76 Italian catheterization laboratories. Each center had a 60-day window to include consecutive cases that fulfilled the inclusion and exclusion criteria. Two pre-specified groups were enrolled: 1) patients who had operators apply fractional flow reserve or instantaneous wave-free ratio assessment (physiology assessment group); and 2) patients who had operators decide not to perform fractional flow reserve or instantaneous wave-free ratio assessment, although the patients met the inclusion and exclusion criteria (visual estimation group).
Results Overall, 1,858 cases were included (physiology assessment group, n = 1,177; visual estimation group, n = 681). Physiology-based guidance was used in 7% and 13% of the total volume of angiographic and percutaneous coronary interventions, respectively. Its use was in line with European and American guidelines in 48% of the cases (n = 569). Physiology guidance was used in a consistent number of patients with acute coronary syndromes (n = 529 [45%]). The main reason for not using physiology guidance was the operator’s confidence that clinical and angiographic data alone were sufficient.
Conclusions Use of coronary physiology assessment in daily practice meets the current guideline indications in approximately 50% of cases. The major limiting factor for the adoption of physiology guidance was the operator’s confidence in visual assessment alone. (Evolving Routine Standards of FFR Use [ERIS]; NCT03082989)
- acute coronary syndrome(s)
- fractional flow reserve
- instantaneous wave-free ratio
- percutaneous coronary intervention
- stable coronary artery disease
This study was an investigator-driven clinical trial conducted by Società Italiana di Cardiologia Interventistica. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 1, 2018.
- Revision received April 13, 2018.
- Accepted April 26, 2018.
- 2018 American College of Cardiology Foundation
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