Optimising physiological endpoints of percutaneous coronary intervention.

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Technology

Background:

• Invasive coronary physiology is established for stable coronary artery disease management.
• It improves outcomes and cost-efficiency compared to angiography alone.
• Recent trials question the value of traditional ischemia testing for revascularization decisions.

Purpose of the Study:

• To review the evolving role of invasive coronary physiology in stable coronary artery disease.
• To explore its transition from a dichotomous test to real-time guidance for percutaneous coronary intervention (PCI).
• To discuss advanced indices and post-PCI assessments for optimizing revascularization.

Main Methods:

• Review of contemporary evidence on ischemia testing in stable coronary artery disease.
• Examination of emerging indices for advanced physiological guidance of PCI.
• Discussion of rationale and evidence for post-PCI physiological assessments.

Main Results:

• Traditional ischemia testing's value is debated by recent randomized controlled trials.
• 20-40% of patients experience persistent angina after successful PCI.
• Emerging indices offer advanced physiological guidance during PCI.

Conclusions:

• The role of invasive coronary physiology is shifting towards real-time PCI guidance.
• Optimizing physiological results during PCI is crucial.
• Post-PCI assessments are vital to confirm successful revascularization and improve patient outcomes.