Functional Patterns of Coronary Disease: Diffuse, Focal, and Serial Lesions

Area of Science:

• Cardiology
• Interventional Cardiology
• Physiological Assessment

Background:

• Coronary artery disease (CAD) presents in various patterns: focal, serial, diffuse, and mixed.
• These patterns influence the accuracy of pressure wire and angiography-derived physiological indexes.
• Diffuse CAD significantly impacts percutaneous coronary intervention (PCI) outcomes.

Purpose of the Study:

• To review current evidence on functional CAD patterns.
• To define physiological patterns of CAD and their diagnostic/therapeutic implications.
• To provide a practical algorithm for optimizing physiological assessment in PCI.

Main Methods:

• State-of-the-art literature review.
• Analysis of diagnostic and therapeutic implications of CAD patterns.
• Development of a practical algorithm for physiological assessment.

Main Results:

• Current classification of physiological CAD patterns is poorly defined.
• Functional patterns of CAD impact PCI planning and outcomes.
• An algorithm is proposed to optimize the use of pressure wire and angiography-derived indexes.

Conclusions:

• Accurate identification of CAD physiological patterns is essential for tailored patient management.
• The proposed algorithm aids in optimizing PCI procedural planning.
• Integrating intracoronary imaging can further refine assessment in select cases.