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Vol 26, No 3 (2019)
POSITION PAPER
Published online: 2019-06-12

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Consensus document for invasive coronary physiologic assessment in Asia-Pacific countries

Hak Seung Lee1, Joo Myung Lee2, Chang-Wook Nam3, Eun-Seok Shin4, Joon-Hyung Doh5, Neng Dai6, Martin K.C. Ng7, Andy S.C. Yong8, Damras Tresukosol9, Ajit S.  Mullasari10, Rony Mathew11, Praveen Chandra12, Kuang-Te Wang13, Yundai Chen14, Jiyan Chen15, Kai-Hang Yiu16, Nils P. Johnson17, Bon-Kwon Koo1
DOI: 10.5603/CJ.a2019.0054
Pubmed: 31225632
Cardiol J 2019;26(3):215-225.

Abstract

Background: Currently, invasive physiologic assessment such as fractional flow reserve is widely used worldwide with different adoption rates around the globe. Patient characteristics and physician preferences often differ in the Asia-Pacific (APAC) region with respect to treatment strategy, techniques, lesion complexity, access to coronary physiology and imaging devices, as well as patient management. Thus, there is a need to construct a consensus document on recommendations for use of physiology-guided percutaneous coronary intervention (PCI) in APAC populations. This document serves as an overview of recommendations describing the best practices for APAC populations to achieve more consistent and optimal clinical outcomes. 

Methods and Results: A comprehensive multiple-choice questionnaire was provided to 20 interven- tional cardiologists from 10 countries in the APAC region. Clinical evidence, tips and techniques, and clinical situations for the use of physiology-guided PCI in APAC were reviewed and used to propose key recommendations. There are suggestions to continue to develop evidence for lesion and patient types that will benefit from physiology, develop directions for future research in health economics and local data, develop appropriate use criteria in different countries, and emphasize the importance of education of all stakeholders. A consensus recommendation to enhance the penetration of invasive physiology-based therapy was to adopt the 5E approach: Evidence, Education, Expand hardware, Economics and Expert consensus. 

Conclusions: This consensus document and recommendations support interventional fellows and cardiologists, hospital administrators, patients, and medical device companies to build confidence and encourage wider implementation of invasive coronary physiology-guided therapy in the APAC region. 

Keywords: coronary physiologyinvasive physiologic assessmentquality improvement

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