Ischemia-guided percutaneous coronary intervention for patients with stable coronary artery disease

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Evidence

Background:

• Current guidelines recommend ischemia-guided revascularization for stable coronary symptoms.
• Revascularization often targets anatomical stenosis (percutaneous coronary intervention, coronary artery bypass surgery) without confirming myocardial ischemia.
• Complete anatomical revascularization is traditionally favored, especially in multivessel disease.

Purpose of the Study:

• To review the strengths and weaknesses of anatomical versus functional revascularization strategies.
• To explore recent evidence contradicting the concept of complete anatomical revascularization.
• To highlight the benefit of ischemia-guided selective revascularization based on functional evaluation.

Main Methods:

• Review of current evidence and guidelines.
• Analysis of observational studies on revascularization strategies.
• Exploration of noninvasive and invasive functional evaluation techniques.

Main Results:

• Observational studies suggest benefits of ischemia-guided selective revascularization.
• Functional evaluation identifies ischemia-producing coronary lesions.
• Angiographic complete revascularization may not be superior.

Conclusions:

• Ischemia-guided selective revascularization shows promise, particularly for multivessel disease.
• Functional assessment of coronary lesions is crucial for optimal treatment.
• Further trials are needed to definitively compare anatomical vs. functional revascularization.