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Narbeh Melikian1, Francesca Del Furia, Carlo Di Mario

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Coronary angiography has limitations in assessing coronary artery disease severity. Fractional flow reserve (FFR) provides crucial functional data, guiding ischemia-driven revascularization for better patient outcomes.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Coronary angiography's 2D silhouette has limitations in depicting true luminal morphology and functional impact.
  • Discrepancies between angiographic findings and clinical presentation are common, especially in intermediate stenoses.
  • Accurate physiologic indices are needed to complement angiography in cardiac catheterization.

Purpose of the Study:

  • To highlight the limitations of coronary angiography.
  • To emphasize the role of physiologic indices in guiding coronary revascularization.
  • To position fractional flow reserve (FFR) as a key tool in managing coronary artery disease.

Main Methods:

  • Review of limitations of 2D coronary angiography.
  • Discussion of the validation and clinical availability of physiologic indices.
  • Highlighting fractional flow reserve (FFR) as the gold standard.

Main Results:

  • Physiologic indices improve the accuracy of stenosis assessment compared to angiography alone.
  • Ischemia-driven revascularization based on physiologic data improves clinical outcomes.
  • Fractional flow reserve (FFR) is indicated for intermediate stenoses, left main, ostial, and serial lesions.

Conclusions:

  • Physiologic indices, particularly FFR, are essential adjuncts to angiography.
  • Utilizing FFR streamlines patient management in cardiac catheterization.
  • An "all-in-one" ischemia-driven revascularization service improves efficiency and outcomes.