Coronary physiology in the catheterization laboratory: current practices, historical insights, and future directions

Coronary flow improvement and myocardial ischemia relief are the primary goals of coronary revascularization. The pioneering work of Andreas Gruntzig, who demonstrated the reduction of trans-stenotic pressure gradients following percutaneous coronary intervention (PCI), marked a major milestone in the field. Since then, a variety of invasive and non-invasive techniques for assessing coronary physiology have been developed. These methods play a pivotal role in evaluating the hemodynamic significance of coronary lesions, guiding PCI planning, optimizing post-PCI outcomes, and assessing coronary microcirculation and disease patterns. This review explores the available tools for coronary physiology assessment in the catheterization laboratory and their applications in the decision-making process for coronary revascularization. In addition, it highlights recent technological advances, such as invasive and coronary image-based computational methods. These innovations enable individualized PCI treatment, aiming for complete ischemia relief through optimized morpho-functional procedural outcomes.