Based on the 2012 intravascular diagnostic CER and our discussion with stakeholders, we identified 12 potential research areas, three of which were ranked as high priority areas of future research. Two topics (one on the use of intravascular physiologic measurements like fractional flow reserve in treatment decisionmaking before stenting; one on the impact of the use of intravascular imaging diagnostics on stenting) are based directly on evidence gaps identified in the CER. One topic on the added value of intravascular diagnostic techniques in patients with clear clinical and other indications for revascularization was raised by the stakeholders.
Our CER focused on the use of intravascular diagnostics and excluded noninvasive techniques. Therefore, evidence on the use of newer non-invasive techniques like chest computed tomography angiography with coronary computed tomography angiography (CCTA) in patients being considered for stenting has not been reviewed. The future research needs concerning the adjunctive use of noninvasive diagnostic techniques, perhaps in combination of invasive ones, will require a systematic evidence review and see what the gaps are.
The recommendations for priority topics for future research were generated based on a stakeholder-driven nomination and review process. We followed a recently developed taxonomy that was designed to aid researchers in the identification, recruitment and engagement of stakeholders. Our stakeholder panel represented a broad range of perspectives, across all major stakeholder categories identified in this taxonomy. Of 11 stakeholders who were invited, 10 participated in the teleconferences, and 9 participated in the prioritization process.
The use of intravascular diagnostics in patients being considered for percutaneous coronary artery stenting is a highly technical topic and requires considerable domain knowledge to appreciate how these adjunctive diagnostics aid traditional coronary artery catheterization and stenting. Added to this difficulty is the challenge of defining optimal stent placement; this concept has permeated the clinical community but standards have not been established.
To identify priority future research needs we sought and successfully incorporated insight from clinical experts as well as from insurance, hospital, patient and policy experts. Additionally, we have asked domain experts to review the description of the technical details concerning these diagnostic devices, to assure that it is faithful to the complex clinical details of intravascular diagnostic technology as applied to cardiovascular disease.
Agency for Healthcare Research and Quality (US), Rockville (MD)
Ip S, Raman G, Concannon TW, et al. Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 104 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Feb. (Future Research Needs Papers, No. 25.) Discussion.