Functional Angioplasty: Definitions, Historical Overview, and Future Perspectives

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Percutaneous coronary intervention (PCI) is a common treatment for obstructive coronary artery disease (CAD).
• While its role in acute coronary syndromes is clear, its benefit in stable CAD, particularly regarding prognosis, remains debated.
• PCI often alleviates angina symptoms but may not alter long-term outcomes.

Purpose of the Study:

• To review the current understanding of myocardial ischemia in stable CAD.
• To evaluate the evidence supporting PCI guidance and complete revascularization (CR).
• To discuss challenges in defining inducible myocardial ischemia and propose ideal definitions and PCI strategies.

Main Methods:

• Review of existing studies on myocardial ischemia, PCI, and revascularization strategies.
• Analysis of diagnostic tools for assessing inducible myocardial ischemia.
• Discussion of clinical relevance of ischemia hallmarks like ECG changes and wall motion abnormalities.

Main Results:

• Complete revascularization (CR) of all ischemia-causing lesions may be associated with better outcomes compared to incomplete revascularization.
• Inconsistent definitions of inducible myocardial ischemia across studies hinder direct comparisons.
• No universally agreed-upon reference standard exists for diagnosing inducible myocardial ischemia.

Conclusions:

• Standardizing the definition of inducible myocardial ischemia is crucial for comparing study outcomes.
• Clinically relevant ischemia hallmarks may serve as a reference standard.
• Optimizing PCI strategy based on a clear definition of ischemia is essential for improving patient prognosis in stable CAD.