Korean J Intern Med.  2013 Jan;28(1):1-7. 10.3904/kjim.2013.28.1.1.

Physiologic approach for coronary intervention

• Fearon WF

• KMID: 1793211
• DOI: http://doi.org/10.3904/kjim.2013.28.1.1

Abstract

When invasively assessing coronary artery disease, the primary goal should be to determine whether the disease is causing a patient's symptoms and whether it is likely to cause future cardiac events. The presence of myocardial ischemia is our best gauge of whether a lesion is responsible for symptoms and likely to result in a future cardiac event. In the catheterization laboratory, fractional flow reserve (FFR) measured with a coronary pressure wire is the reference standard for identifying ischemia-producing lesions. Its spatial resolution is unsurpassed with it not only being vessel-specific, but also lesion-specific. There is now a wealth of data supporting the accuracy of measuring FFR to identify ischemia-producing lesions. FFR-guided percutaneous coronary intervention of these lesions results in improved outcomes and saves resources. Non-hemodynamically significant lesions can be safely managed medically with a low rate of subsequent cardiac events.

Keyword

Coronary disease; Coronary physiology

MeSH Terms

*Cardiac Catheterization
Coronary Artery Disease/complications/*diagnosis/physiopathology/therapy
*Coronary Circulation
Fractional Flow Reserve, Myocardial
*Hemodynamics
Humans
Patient Selection
Percutaneous Coronary Intervention
Predictive Value of Tests
Treatment Outcome