Physiologic approach for coronary intervention.
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.
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 94305, USA. wfearon@stanford.edu
William F
WF
Fearon
D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016896:Treatment Outcome
Coronary disease; Coronary physiology