„All-in-one“ concept of functional myocardial revascularization in the cathlab

The concept of functional revascularization based on proving ischemia has been strongly recommended in the practical guidelines of both European and Czech Societies of Cardiology. In daily practice, application of this concept decreases the rate of coronary interventions. Though the best clinical evidence has been provided in patients with chronic coronary syndromes, recent data strongly advocate its usage also in patients with acute coronary syndromes. Invasive pressure-derived indices: hyperemic FFRmyo (fractional flow reserve of myocardium) and resting iFR (instantaneous wave-free ratio) require an interventional procedure by wiring the diseased vessel. FFRmyo 0.80 and iFR 0.89 mean functionally significant coronary disease mostly indicated for revascularization. Besides that, there are several non-invasive functional tests that may be used for detecting ischemia: perfusion scintigraphy, cardiovascular magnetic resonance, positron emission tomography and recently developed FFRCT or quantitative flow ratio (QFR). In routine practice, the concept of functional revascularization avoids unneccessary coronary interventions and, in case of functionally non-significant disease/stenoses, the patients may be treated conservatively with a very good prognosis. Currently, the „functionally complete revascularization“, instead of the anatomic one, might become the goal of our treatment as the all-in-one concept in the cathetrization laboratory.