Protocol Variation in Functional Coronary Angiography Among Patients With Suspected Angina With Non-Obstructive Coronary Arteries: A Nationwide Snapshot of Current Practice Within Australia and New Zealand.

Autor: Spiro J; Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia. Electronic address: jonathan.spiro@uwa.edu.au., Ford TJ; Department of Cardiology, Gosford Hospital, Central Coast Local Health District, Gosford, NSW, Australia., Yong A; Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia., Zeitz C; Department of Cardiology, Royal Adelaide Hospital and The Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, Basil Hetzel Institute, Adelaide, SA, Australia., Beltrame JF; Department of Cardiology, Royal Adelaide Hospital and The Queen Elizabeth Hospital, Adelaide, SA, Australia; University of Adelaide, Basil Hetzel Institute, Adelaide, SA, Australia.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2024 Sep; Vol. 33 (9), pp. 1287-1296. Date of Electronic Publication: 2024 Jun 30.
DOI: 10.1016/j.hlc.2024.04.299
Abstrakt: Background: Functional coronary angiography (FCA) for endotype characterisation (vasospastic angina [VSA], coronary microvascular disease [CMD], or mixed) is recommended among patients with angina with non-obstructive coronary arteries. Whilst clear diagnostic criteria for VSA and CMD exist, there is no standardised FCA protocol. Variations in testing protocol may limit the widespread uptake of testing, generalisability of results, and expansion of collaborative research. At present, there are no data describing protocol variation across an entire geographic region. Therefore, we aimed to capture current practice variations in the approach to FCA to improve access and standardisation for diagnosis of coronary vasomotor disorders in Australia and New Zealand.
Method: Between July 2022 and July 2023, we conducted a national survey across all centres in Australia and New Zealand with an active FCA program. The survey captured attitudes towards FCA and protocols used for diagnosis of coronary vasomotor disorders at 33 hospitals across Australia and New Zealand.
Results: Survey responses were received from 39 clinicians from 33 centres, with representation from centres within all Australian states and territories and both North and South Islands of New Zealand. A total of 21 centres were identified as having an active FCA program. In general, respondents agreed that comprehensive physiology testing helped inform clinical management. Barriers to program expansion included cost, additional catheter laboratory time, and the absence of an agreed-upon national protocol. Across the clinical sites, there were significant variations in testing protocol, including the technique used (Doppler vs thermodilution), order of testing (hyperaemia resistance indices first vs vasomotor function testing first), rate and dose of acetylcholine administration, routine use of temporary pacing wire, and routine single vs multivessel testing. Overall, testing was performed relatively infrequently, with very little follow-on FCA performed, despite nearly all respondents believing this would be clinically useful.
Conclusions: This survey demonstrates, for the first time, variations in FCA protocol among testing centres across two entire countries. Furthermore, whilst FCA was deemed clinically important, testing was performed relatively infrequently with little or no follow-on testing. Development and adoption of a standardised national FCA protocol may help improve patient access to testing and facilitate further collaborative research within Australia and New Zealand.
Competing Interests: Conflicts of Interest The Cardiac Society of Australia and New Zealand (CSANZ) Coronary Vasomotor Dysfunction Working Group is an independent physician-led organisation without any financial relationship to industry. Individual authors have the following relevant disclosures. J.S. has received speaker fees and an unrestricted educational grant from Abbott Vascular. T.J.F. has received speaker fees from Abbott Vascular and Boston Scientific. A.Y. received speaker fees and research support from Abbott Vascular, and research support from Philips. C.Z. has received speaker fees from Abbott Vascular. J.F.B. has no conflicts of interest to disclose.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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