Ischaemic and viability testing for guiding PCI are overrated: pros and cons

Introduction

Over the years, establishing indications and appropriate candidates for percutaneous coronary intervention (PCI) has been a subject of investigation, with the concepts of “ischaemia” and “viability” playing important roles. Ischaemia, caused by a mismatch between myocardial oxygen demand and supply, has long been a pillar of decision-making in the field of interventional cardiology. Similarly, viability − based on the theory of hibernating myocardium − has been considered a key criterion to avoid futile PCI procedures. However, the main findings and subanalyses of randomised trials that have been published over the last few years have significantly challenged the usefulness of ischaemia and viability testing for guiding PCI. In light of current evidence, whether ischaemia and viability testing maintain an important role, or are limited to selected patients or scenarios, is an area of uncertainty.

Pros

Margaret B. McEntegart, MD, PhD; Anja Oksnes, MD

The concept that ischaemic and viability testing should guide percutaneous coronary intervention has been firmly ingrained in cardiology practice. However, the recent challenge to this paradigm by the ISCHEMIA and REVIVED-BCIS2 trials prompts the...