The Concept of Functional Percutaneous Coronary Intervention: Why Physiologic Lesion Assessment Is Integral to...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Coronary angiography is the traditional standard for assessing coronary artery stenosis severity.
• Clinical trials show that angiography alone does not ensure patient benefit from interventions.
• Physiologic assessment offers a more functional evaluation of stenoses.

Purpose of the Study:

• To highlight the limitations of anatomic assessment by coronary angiography alone.
• To emphasize the role of fractional flow reserve (FFR) in physiologic lesion assessment.
• To advocate for the integration of FFR into decision-making for coronary revascularization.

Main Methods:

• Review of multicenter randomized clinical trials comparing angiography-guided vs. physiology-guided revascularization.
• Discussion of the principles and application of fractional flow reserve (FFR) measurement.
• Analysis of the impact of FFR on clinical outcomes and healthcare resource utilization.

Main Results:

• Treatment decisions based solely on coronary angiography do not consistently improve patient outcomes.
• The use of fractional flow reserve (FFR) for physiologic assessment leads to improved clinical outcomes.
• FFR-guided revascularization enhances the appropriateness of cardiac catheterization procedures.

Conclusions:

• Fractional flow reserve (FFR) is a crucial adjunct to coronary angiography for comprehensive stenosis assessment.
• Physiologic assessment using FFR improves clinical decision-making for coronary revascularization.
• Integrating FFR is essential in the current healthcare environment focused on procedural appropriateness and patient benefit.