title: Functional Versus Anatomic Imaging of CAD: Lessons Learned from Recent Clinical Trials.
abstract: Recent clinical trials directed at imaging of coronary artery disease (CAD) have demonstrated a paradigm shift away from endpoints related to detection of CAD in favor of those related to clinical outcomes. The objective of such trials has been to determine whether physiological metrics are superior to anatomical ones for guiding therapy and improving outcomes in patients with known or suspected CAD. The present review focuses on selected trials in this area in particular DEFER, FAME 1 and 2, a meta-analysis comparing FFR to anatomically guided treatment outcomes and COURAGE SPECT MPI sub study. The rationale for using physiological as opposed to anatomical endpoints to optimize patient management, in particular coronary revascularization decisions, is emphasized. The results of the FFR-based trials are concordant and indicate physiological metrics are superior to anatomical ones for guiding therapy and improving clinical outcomes in patients with known or suspected CAD.
authors.affiliation: Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Cardiac Unit/Yawkey 5E, 55 Fruit Street, Boston, MA, 02114, USA. gewirtz.henry@mgh.harvard.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Gewirtz
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic
keywords: CAD clinical outcomes trials; Coronary revascularization; Coronary stenosis; Fractional flow reserve; PET myocardial blood flow