In patients with chest pain suggestive of stable angina , ESC Guidelines recommend non invasive stress testing to assess the need for invasive coronary angiography when the pre-test probability indicates an intermediate risk with direct referral for catheterization only when the patients are at high risk. The goal of these recommendations is to enhance the diagnostic yield of cardiac catheterization as well as to limit the number of patients found not to have obstructive coronary artery disease. Therefore an appropriate use of noninvasive tests should result in more effective risk stratification, allowing identification of those patients who would be most likely to benefit from invasive coronary angiography and subsequently from coronary revascularization procedures. Despite several decades of non-invasive cardiovascular testing experience, improved diagnostic accuracy and risk stratification is still needed . To address these issues , 2 large, randomized trials ( the SCOT-HEART and PROMISE) explored the diagnostic evaluation of patients with symptoms suspected for coronary heart disease. It is not known however how cardiologists incorporate the results of these pivotal trials into current clinical practice. Still many invasive procedures and percutaneous coronary interventions (PCI) are performed without prior use of diagnostic tests ( either functional or anatomical ) to substantiate the suspect of the presence of coronary artery disease . Studies conducted in U.S. demonstrate that 1 in 6 non acute PCI were classified as inappropriate , indicating that the benefits of the procedure were unlikely to outweigh the risks with substantial variation in the proportion of non acute PCIs considered inappropriate across hospitals. Another important issue concerns the assessment of severity of a coronary narrowing shown by invasive coronary angiography , a necessary step to make decisions as to treat it with coronary angioplasty or not , particularly for “intermediate” stenoses . Although pressure-derived fractional flow reserve (FFR) has become the standard of reference to define the functional significance of epicardial stenoses of intermediate angiographic severity, in daily practice the vast majority of decisions about revascularization are based on visual estimation . The purpose of the workshop is to analyze and discuss these issues which are of paramount importance to guide our clinical practice and for a correct use of resources .
Prof. Stefano De Servi
Scientific Committee of the Workshop