The prognostic value of residual coronary stenoses after functionally complete revascularisation

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Fractional flow reserve (FFR) is the gold standard for assessing coronary artery stenosis severity.
• FFR-guided percutaneous coronary intervention (PCI) shows superiority over angiography-guided PCI.
• High FFR costs limit its routine use, making visual stenosis estimation the primary decision-making tool.

Discussion:

• A significant "visual-functional mismatch" exists between diameter stenosis and FFR in 57% of non-left main stenosis cases.
• Angiography may overestimate lesion significance, potentially leading to unnecessary interventions.
• Complete revascularization improves outcomes in multivessel disease, but functional significance is key.

Key Insights:

• Functional revascularization guided by FFR is crucial for optimal patient outcomes.
• Residual angiographic lesions lacking functional significance do not indicate residual ischemia or predict worse outcomes.
• Prioritizing functional completeness over angiographic completeness ensures effective treatment.

Outlook:

• Further research into cost-effective FFR integration is needed.
• Developing advanced imaging techniques to better predict FFR could improve clinical decision-making.
• Emphasizing functional assessment will refine revascularization strategies and enhance long-term results.