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Multicenter Study
. 2025 Jan 6;21(1):35-45.
doi: 10.4244/EIJ-D-24-00499.

Comprehensive diagnosis in chronic coronary syndromes combining angiography and intracoronary testing: the AID-ANGIO study

Adrián Jerónimo  1 , José G Paredes-Vázquez  1 , Alejandro Travieso  1 , Asad Shabbir  1 , Pilar Jiménez-Quevedo  1 , Fernando Macaya-Ten  1 , Luis Nombela-Franco  1 , Iván J Núñez-Gil  1 , Pablo Salinas  1 , Juan Carlos Gómez-Polo  1 , Daniel García-Arribas  1 , Isidre Vilacosta  1 , Javier García Pérez-Velasco  2 , Eva García-Romo  2 , Alberto García-Lledó  2 , Juan Manuel Grande-Ingelmo  3 , Inmaculada Fernández-Rozas  3 , Javier Alonso-Belló  4 , Alejandro Curcio  4 , Antonio I Fernández-Ortiz  1 , Julián P Villacastín  1 , Hernán Mejía-Rentería  1 , Nieves Gonzalo  1 , Javier Escaned  1
Affiliations
Multicenter Study

Comprehensive diagnosis in chronic coronary syndromes combining angiography and intracoronary testing: the AID-ANGIO study

Adrián Jerónimo et al. EuroIntervention. .

Abstract

Background: The diagnostic yield of invasive coronary angiography (ICA) in patients with chronic coronary syndromes (CCS) in contemporary practice is uncertain.

Aims: We investigated the value of an advanced invasive diagnosis (AID) strategy combining angiography and intracoronary testing.

Methods: AID-ANGIO is an all-comers, prospective, multicentre study enrolling CCS patients referred for ICA. Obstructive coronary artery disease (CAD) was investigated with angiography and pressure guidewires. In the absence of obstructive CAD, intracoronary testing for ischaemia with non-obstructive coronary arteries (INOCA) was performed. The primary endpoint was the proportion of patients with a cause of ischaemia identified by the AID strategy. To assess the effect of AID on decision-making, an initial therapeutic plan was first prepared by clinical cardiologists based on ICA and medical information. Subsequently, based on AID data, a final therapeutic plan was drafted by clinical and interventional cardiologists (Ischaemia Team).

Results: We enrolled 317 patients (44.2% female). Based on ICA, obstructive CAD was diagnosed in 32.2% of patients. With the AID strategy, a cause of myocardial ischaemia was identified in 84.2% (p<0.001): obstructive CAD in 39.1% and INOCA in 45.1%. Only 15.8% of patients did not show any abnormalities. Modification of the original treatment plan with the AID strategy occurred in 59.9% of cases.

Conclusions: In assessing ischaemia-generating coronary abnormalities, prespecified use of the AID strategy was associated with a 2.6-fold increase in diagnostic yield compared with ICA (84.2% vs 32.2%, respectively), largely due to the identification of INOCA. Modification of the therapeutic plan with the AID strategy occurred in 59.9% of cases. (ClinicalTrials.gov: NCT05635994).

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Conflict of interest statement

A. Jerónimo is supported by Sociedad Española de Cardiología through a mobility grant (SEC/PRS-MOV-INT 24). N. Gonzalo has received speaker and consultancy fees from Abbott, Boston Scientific, and Philips. J. Escaned is supported by the Intensification of Research Activity project INT22/00088 from Spanish Instituto de Salud Carlos III; and declares having served as speaker and advisory board member for Abbott and Philips. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Schematic representation of the advanced invasive diagnosis (AID) algorithm.
The AID strategy combines invasive angiography with intracoronary testing to outline obstructive and non-obstructive causes of myocardial ischaemia. ACh: acetylcholine; CFR: coronary flow reserve; FFR: fractional flow reserve; ICA: invasive coronary angiography; IMR: index of microcirculatory resistance; RFR: resting full-cycle ratio
Figure 2
Figure 2. Diagnostic yield of ICA and the AID strategy.
The left column shows the number of patients with severe- and intermediate-grade stenoses and those with angiographically normal coronary arteries. The right column shows the final diagnosis, based on the AID strategy. AID: advanced invasive diagnosis; CAD: coronary artery disease; ICA: invasive coronary angiography; INOCA: ischaemia with non-obstructive coronary arteries
Figure 3
Figure 3. Impact of the AID strategy on clinical decision-making.
The tentative therapeutic plan (left column), which had been laid out by clinical cardiologists based on angiography and clinical information alone, changed after the application of the AID strategy (right column). Linking bars with the same colour indicate no change in the treatment plan. Light grey linking bars indicate a modification of treatment, even inside the same treatment category (for example, change in PCI targets or INOCA endotype). AID: advanced invasive diagnosis; CABG: coronary artery bypass graft; CAD: coronary artery disease; INOCA: ischaemia with non-obstructive coronary arteries; PCI: percutaneous coronary intervention
Figure 4
Figure 4. Final diagnosis and therapeutic plan in patients in whom INOCA was initially suspected.
Among patients in whom the clinical cardiologist initially suspected INOCA, a correct diagnosis was made in 22% according to the findings in the AID strategy. In the remaining cases, the initial diagnosis was erroneous because of different INOCA endotypes, normal coronary function, or underestimation of obstructive disease. AID: advanced invasive diagnosis; CAD: coronary artery disease; INOCA: ischaemia with non-obstructive coronary arteries
Central illustration
Central illustration. The AID-ANGIO study: characteristics and main results.
A) Baseline patient characteristics. B) ICA alone identified a cause of myocardial ischaemia in 32.2% of the patients. The AID strategy identified a cause of myocardial ischaemia in 84.2% of the patients, which represents a 2.6-fold increase in the diagnostic yield. INOCA was the most prevalent cause of myocardial ischaemia (45.1%). AID: advanced invasive diagnosis; CAD: coronary artery disease; CCS: chronic coronary syndrome; ICA: invasive coronary angiography; INOCA: ischaemia with non-obstructive coronary arteries
See this image and copyright information in PMC

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