The role of physiology in the contemporary management of coronary artery disease

医学 传统PCI 冠状动脉疾病 经皮冠状动脉介入治疗 心脏病学 心绞痛 内科学 部分流量储备 狭窄 冠状动脉粥样硬化 疾病 加拿大心血管学会 冠状动脉造影 心肌梗塞
作者
Francesca Rubino,Graziella Pompei,Salvatore Brugaletta,Carlos Collet,Vijay Kunadian
出处
期刊:Heart [BMJ]
卷期号:110 (6): 391-398 被引量:6
标识
DOI:10.1136/heartjnl-2023-322641
摘要

Coronary physiology assessment, including epicardial and microvascular investigations, is a fundamental tool in the contemporary management of patients with coronary artery disease. Coronary revascularisation guided by functional evaluation has demonstrated superiority over angiography-only-guided treatment. In patients with chronic coronary syndrome, revascularisation did not demonstrate prognostic advantage in terms of mortality over optimal medical therapy (OMT). However, revascularisation of coronary stenosis, which induces myocardial ischaemia, has demonstrated better outcome than OMT alone. Pressure wire (PW) or angiography-based longitudinal coronary physiology provides a point-by-point analysis of the vessel to detect the atherosclerotic pattern of coronary disease. A careful evaluation of this disease pattern allows clinicians to choose the appropriate management strategy. Patients with diffuse disease showed a twofold risk of residual angina after percutaneous coronary intervention (PCI) than those with focal disease. Therefore, OMT alone or coronary artery bypass graft might be considered over PCI. In addition, the post-PCI physiological assessment aims to optimise the result revealing residual myocardial ischaemia. Improvement in post-PCI PW or angiography-based functional indices has been associated with better quality of life and reduced risk of cardiac events and residual angina. Therefore, the information obtained from coronary physiology allows for an optimised treatment strategy, which ultimately leads to improve patient’s prognosis and quality of life. This review provides an overview of the latest available evidence in the literature regarding the use of functional assessment of epicardial coronary stenosis in different settings in the contemporary patient-tailored management of coronary disease.

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