When Intracoronary Anatomy is Superior to Physiology

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Diagnostic Imaging

Background:

• Physiological assessment is vital for guiding revascularization, overcoming limitations of traditional anatomical and angiographic methods.
• However, physiological measurements can sometimes misrepresent coronary disease severity compared to anatomical findings.

Purpose of the Study:

• To review clinical scenarios where anatomical assessment is superior to physiological assessment for revascularization decisions.
• To discuss strategies for overcoming limitations of physiological measurements in complex cases.

Main Methods:

• Review of clinical literature and guidelines on coronary physiology and anatomy.
• Analysis of specific conditions including acute coronary syndromes, left main disease, saphenous vein graft lesions, and myocardial bridging.

Main Results:

• Anatomical evaluation is paramount in acute coronary syndromes, left main disease, SVG lesions, and myocardial bridging.
• Physiological measurements may be misleading in these specific contexts.

Conclusions:

• Understanding the interplay between anatomy and physiology is essential for optimal revascularization strategies.
• Clinical judgment integrating both anatomical and physiological data is key to accurate disease assessment.