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Physiologic Assessment of Coronary Stenosis: Current Status and Future Directions

Sercan Okutucu1, Mehmet Cilingiroglu2,3, Marc D Feldman4

  • 1Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey.

Current Cardiology Reports
|June 3, 2021
PubMed

Insights

Physiology-guided percutaneous coronary intervention (PCI) improves outcomes in coronary artery disease (CAD) by identifying significant blockages. Newer methods offer safe and effective alternatives to traditional fractional flow reserve (FFR) assessment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Percutaneous coronary intervention (PCI) is a standard treatment for coronary artery disease (CAD).
  • Optimal medical therapy (OMT) is an alternative, but PCI offers reduced major adverse cardiovascular events (MACE) when guided by lesion significance.
  • Despite evidence, physiology-guided PCI is underutilized in clinical practice.

Purpose of the Study:

  • To review the evidence supporting physiology-guided PCI.
  • To summarize current methods for assessing coronary stenosis physiology.
  • To highlight the importance of accurate lesion assessment for revascularization decisions.

Main Methods:

  • Review of existing literature on coronary physiology assessment.
  • Discussion of fractional flow reserve (FFR) as the gold standard.
  • Introduction of non-hyperemic ratios and quantitative flow reserve as alternative indices.

Main Results:

  • Fractional flow reserve (FFR) is the established standard for lesion severity assessment.
  • Non-hyperemic indices and quantitative flow reserve demonstrate safety and effectiveness.
  • Physiological assessment resolves ambiguities from coronary angiography, guiding treatment decisions.

Conclusions:

  • Accurate physiological assessment of coronary stenosis is crucial for optimal PCI outcomes.
  • Technological advancements offer alternatives to traditional FFR, improving patient care.
  • Increased adoption of physiology-guided PCI can enhance MACE reduction in CAD patients.
Abstract

Keywords:
AngiographyCoronary artery diseaseFractional flow reserveInstantaneous wave-free ratioPhysiology

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