Percutaneous coronary intervention in patients with multi-vessel coronary artery disease: a focus on physiology
Yun-Kyeong Cho1, Chang-Wook Nam1
1Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) effectively addresses complex multi-vessel coronary artery disease (MVD). This approach optimizes lesion selection and improves both early and late outcomes in MVD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Multi-vessel coronary artery disease (MVD) presents complex lesions requiring revascularization.
- Percutaneous coronary intervention (PCI) for MVD faces challenges in lesion identification, treatment selection, and long-term outcomes.
Purpose of the Study:
- To review the application of physiology-guided PCI in managing MVD.
- To evaluate the early and late outcomes associated with physiology-guided PCI for MVD.
Main Methods:
- Utilizing fractional flow reserve (FFR) for physiology-guided decision-making in PCI.
- Reviewing recent clinical trials and patient data for MVD treated with FFR-guided PCI.
Main Results:
- Physiology-guided decision-making overcomes limitations of traditional PCI in MVD.
- FFR guidance aids in appropriate lesion selection and revascularization strategy.
- Positive early and late outcomes are observed with FFR-guided PCI in MVD.
Conclusions:
- Physiology-guided PCI, particularly FFR, is a valuable strategy for MVD management.
- Optimal patient selection and lesion targeting are crucial for successful MVD treatment.
- FFR-guided PCI offers a robust approach for MVD regardless of clinical presentation or subtype.
Abstract:
Multi-vessel coronary artery disease (MVD) frequently features ambiguous or intermediate lesions that may be both serial and complex, suggesting that multiple regions require revascularization. Percutaneous coronary intervention (PCI) is associated with various challenges such as appropriate identification of lesions that should be treated, the choice of an optimum revascularization method, and limitations of long-term outcomes. Optimal patient selection and careful targeting of lesions are key when planning treatment. Physiology-guided decision-making (based on the fractional flow reserve) can overcome the current limitations of PCI used to treat MVD regardless of clinical presentation or disease subtype, as confirmed in recent clinical trials. Here, we review the use of physiology-guided PCI for patients with MVD, and their early and late outcomes.
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