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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Functional Assessment of Coronary Artery Lesions-Old and New Kids on the Block

Prashant Patel1,2, Ravi Rao1,2, Prabhdeep Sethi1,2

  • 1Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California.

The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
|May 24, 2021
PubMed

Insights

Coronary angiography often overestimates lesion severity. Invasive or noninvasive functional assessment is crucial for guiding revascularization in stable ischemic heart disease (SIHD) to improve clinical outcomes.

Area of Science:

  • Cardiovascular medicine
  • Interventional cardiology

Background:

  • Coronary angiography frequently overestimates the functional significance of coronary lesions.
  • Angiography-guided revascularization has not improved hard clinical outcomes in stable ischemic heart disease (SIHD).

Purpose of the Study:

  • To review the physiological basis, tools, techniques, and evidence for invasive and noninvasive methods of functional assessment of coronary lesions.
  • To highlight the importance of functional assessment in guiding revascularization decisions for SIHD.

Main Methods:

  • Review of physiological principles underlying coronary lesion assessment.
  • Discussion of various invasive (resting and hyperemic) and noninvasive assessment tools and techniques.
  • Examination of evidence from contemporary clinical trials validating these indices.

Main Results:

  • Angiography alone is insufficient for determining the functional impact of coronary stenoses.
  • Functional assessment is recommended by current guidelines for SIHD when ischemia is not previously established.
  • Novel methods and recent clinical trials are advancing the field of functional lesion assessment.

Conclusions:

  • Accurate functional assessment of coronary lesions is essential for appropriate revascularization in SIHD.
  • Special considerations are needed for complex lesions like left main stenosis, bifurcation lesions, serial stenosis, and acute coronary syndromes.
  • Invasive and noninvasive functional assessments offer improved accuracy over angiography alone for guiding treatment decisions.

Keywords:
angioplastycoronary artery diseasecoronary stenosisfunctional significanceperfusion

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