Research Activities, May 2013
Review compares approaches for determining need for stenting in patients with coronary artery disease
Comparative Effectiveness Research
There is moderate strength of evidence to suggest that use of fractional flow reserve to decide whether intermediate coronary lesions require stenting reduces risk of death, heart attack, major adverse cardiac events, and procedure costs, and leads to fewer stents implanted compared with stenting decisions based on angiography alone. That’s the conclusion of a new research review from AHRQ. It compares the effectiveness of various methods for determining whether coronary stenting is necessary for patients with coronary artery disease. There is also moderate strength of evidence to suggest that the use of intravascular ultrasound to guide stent optimization reduces repeat revascularizations and restenosis, but does not affect mortality or heart attack rates compared with angiography alone. However, the majority of the eligible studies focused on men with lower grade coronary artery disease.
Future studies should include a more representative proportion of women and patients with more serious coronary artery diseases. Future work will also need to evaluate long-term patient outcomes. There is insufficient evidence on how different intravascular diagnostic techniques compare to each other in their effects on therapeutic decisionmaking, intermediate outcomes, and patient-centered outcomes.
These findings can be found in the research review, Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Artery Stenting: Comparative Effectiveness Review at http://go.usa.gov/TKaj.