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Functional Approach for Coronary Artery Disease: Filling the Gap Between Evidence and Practice

Joo Myung Lee1, Joon Hyung Doh2, Chang Wook Nam3

  • 1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Korean Circulation Journal
|March 21, 2018
PubMed

Insights

Fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) guide coronary artery disease treatment. This review explores unresolved questions regarding these pressure wire assessments and microvascular dysfunction in patient prognosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Physiology

Background:

  • Myocardial ischemia is a key prognostic factor in coronary artery disease (CAD).
  • Ischemia-guided revascularization is a standard of care for CAD patients.
  • Pressure wire assessment, including Fractional Flow Reserve (FFR), guides revascularization decisions.

Purpose of the Study:

  • To review recent studies addressing unresolved issues in pressure wire assessment for CAD.
  • To explore the mechanisms of discordance between resting and hyperemic indices.
  • To evaluate the role of physiologic indices and microvascular dysfunction in patient prognosis.

Main Methods:

  • Review of recent clinical studies and trials.
  • Analysis of data comparing FFR and instantaneous wave free ratio (iFR).
  • Investigation into the impact of discordant physiologic index results and microvascular dysfunction.

Main Results:

  • FFR-guided revascularization is superior to angiography-guided strategy.
  • The hyperemia-free index, iFR, demonstrated non-inferiority to FFR in clinical outcomes.
  • Several unresolved issues remain, including index discordance and microvascular dysfunction's role.

Conclusions:

  • Pressure wire assessment provides valuable guidance for revascularization in CAD.
  • Further research is needed to address discordance between indices and the prognostic role of microvascular dysfunction.
  • Optimizing the use of physiologic indices beyond per-vessel decisions is crucial for improving patient outcomes.

Keywords:
Coronary artery stenosisCoronary physiologyInvasive physiologic assessmentIschemic heart disease

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