GISE/ANMCO/SIC Consensus document on the implementation of the new recommendations for the use of coronary functional testing and intravascular imaging in coronary angioplasty for chronic coronary syndromes

Chronic coronary syndromes require an integrated diagnostic-therapeutic approach that combines anatomical, functional, and morphological assessments. The 2024 ESC guidelines assign a key role to intravascular imaging and invasive coronary functional testing to guide percutaneous coronary revascularization and to reduce major adverse cardiovascular events, including cardiac death, myocardial infarction, and repeat revascularization-particularly in patients with complex anatomy – or to reduce angina class/improve quality of life in cases of epicardial and/or microvascular vascular dysfunction. However, the implementation of these strategies in Italy remains limited, characterized by significant geographical disparities and lower utilization rates compared to other European and international countries. Cultural, educational, managerial, and economic barriers continue to hinder the large-scale adoption of these technologies, despite their proven effectiveness in reducing major cardiovascular events. The aim of this GISE/ANMCO/SIC consensus document is to promote a more appropriate and systematic use of functional evaluation and intracoronary imaging in Italian clinical practice, through shared pathways for cultural awareness, training in catheterization laboratories, adjustment of reimbursement systems, and quality monitoring, in order to improve the appropriateness and personalization of care as well as long-term outcomes for patients with chronic coronary syndromes.