Immediate post-procedural functional assessment of percutaneous coronary intervention: current evidence and future...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging & Diagnostics

Background:

• Percutaneous coronary intervention (PCI) improves outcomes, but over 25% of patients experience recurrent symptoms or adverse events.
• Coronary angiography has limitations in assessing PCI efficacy and identifying suboptimal results.
• Immediate post-procedural functional assessment is increasingly recognized for its utility.

Purpose of the Study:

• To review the incidence and mechanisms of suboptimal coronary physiology post-PCI.
• To summarize evidence supporting immediate post-PCI functional assessment for evaluating effectiveness, guiding optimization, and predicting outcomes.
• To discuss the potential impact of post-PCI functional assessment on patient management and secondary prevention.

Main Methods:

• Review of existing literature, including observational studies and post hoc analyses of randomized trials.
• Discussion of the incidence and mechanisms of suboptimal physiology after PCI.
• Synthesis of evidence on the clinical utility of immediate post-PCI functional assessment.

Main Results:

• Higher post-PCI functional results correlate with better clinical outcomes, reduced angina, and fewer repeat revascularizations.
• Immediate post-PCI functional assessment can identify suboptimal results missed by angiography.
• Evidence suggests post-PCI functional assessment can guide optimization and predict outcomes.

Conclusions:

• Immediate post-PCI functional assessment is valuable for evaluating PCI effectiveness and predicting clinical outcomes.
• This assessment has the potential to significantly impact patient management, secondary prevention, and healthcare resource utilization.
• Randomized trials are necessary to determine if post-PCI physiological assessment offers similar benefits to pre-PCI guidance in terms of outcomes and cost-effectiveness.