We read with interest and admiration Eric R. Bates’ generally upbeat “Requiem by a Member of the Inaugural Generation of Interventional Cardiologists” (1); however, his requiem included one dissonant note: “Don’t overuse intravascular imaging.”
As of this writing, published reports include at least 20 randomized clinical trials, 53 registries, and 28 meta-analyses that have compared intravascular imaging–guided versus angiography-guided drug-eluting stent implantation. In the most recent meta-analyses of the randomized clinical trials, intravascular imaging guidance has a mortality advantage compared with angiographic guidance (2), a finding that has also been seen in just about every study comparing intravascular imaging-guided to angiography-guided drug-eluting stent implantation for left main disease (3). Although we acknowledge that intravascular imaging guidance is not Class I in the guidelines, the guideline committees (in both Europe and the United States) have not followed their own rules when it comes to intravascular imaging. Furthermore, we recently surveyed attendees at the 2018 and 2019 Cardiovascular Research Foundation (New York, New York) Interventional Fellows Course as to their preparedness to be independent in the use of intravascular imaging and physiology. Only 15% reported independence in all components of intravascular ultrasound assessment and 18% in all components of optical coherence tomography (4). This is no surprise, given the opinions by an icon such as Bates (1), who commented, “Some of the more than 250 trainees who have had that experience with me may break into a smile if they read this and recall my repetitive exhortations,” including “Don’t overuse intravascular imaging.”
Although we acknowledge and support angiography as the cornerstone of percutaneous coronary intervention, it has several limitations that are overcome by intravascular imaging. Thus, we suggest that “overusing” intravascular imaging is analogous to being “too safe.”
Footnotes
Please note: Dr. Ali has received institutional research grants to Columbia University from Abbott and Cardiovascular Systems Inc.; and has served as a consultant for Abbott, Abiomed, AstraZeneca, and Shockwave. Dr. Mintz has received honoraria from Boston Scientific, Philips, Terumo, and Medtronic.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, or patient consent where appropriate. For more information, visit the JACC: Case Reportsauthor instructions page.
References
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