Physiology-Based Revascularization: A New Approach to Plan and Optimize Percutaneous Coronary Intervention

• Type of Material: Article
• Authors: Joo Myung Lee, SKKU School of Medicine; Seung Hun Lee, SKKU School of Medicine; Dong Shin, Emory University; Ki Hong Choi, SKKU School of Medicine; Tim P van de Hoef, Amsterdam UMC - University of Amsterdam; Hyun Kuk Kim, Chosun University, College of Medicine; Habib Samady, Emory University; Tsunekazu Kakuta, Tsuchiura Kyodo General Hospital; Hitoshi Matsuo, Gifu Heart Center; Bonwon-Kwon Koo, Seoul National University Hospital; William F Fearon, Stanford University; Javier Escaned, Universidad Complutense de Madrid
• Language: English
• Date: 2021-06-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacasi.2021.03.002
• Title of Journal or Parent Work: JACC: Asia
• Volume: 1
• Issue: 1
• Start Page: 14
• End Page: 36
• Grant/Funding Information: Dr. Joo Myung Lee has received a research grant from Abbott Vascular and Philips Volcano; and has received consulting fees from RainMed; Dr. Matsuo has received institutional research support by Phillips; and has received consulting fees from Zeon Medical. Dr. Koo has received an institutional research grant from Abbott Vascular and Philips Volcano.; Dr. Fearon has received institutional research support from Abbott Vascular, Medtronic, and Edwards Lifesciences; and has been a consultant with CathWorks and with HeartFlow.
• Keywords: VOCE, vessel-related composite event; HR, hazard ratio; prognosis; PCI, percutaneous coronary intervention; iFR, instantaneous wave-free ratio; nonhyperemic pressure ratios; DES, drug-eluting stent(s); CI, confidence interval; NHPR, nonhyperemic pressure ratio; MACE, major adverse cardiac event(s); FFR, fractional flow reserve; TVF, target vessel failure; fractional flow reserve; percutaneous coronary intervention; instantaneous wave-free ratio
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Coronary physiological assessment using fractional flow reserve or nonhyperemic pressure ratios has become a standard of care for patients with coronary atherosclerotic disease. However, most evidence has focused on the pre-interventional use of physiological assessment to aid revascularization decision-making, whereas post-interventional physiological assessment has not been well established. Although evidence for supporting the role of post-interventional physiological assessment to optimize immediate revascularization results and long-term prognosis has been reported, a more thorough understanding of these data is crucial in incorporating post-interventional physiological assessment into daily practice. Recent scientific efforts have also focused on the potential role of pre-interventional fractional flow reserve or nonhyperemic pressure ratio pullback tracings to characterize patterns of coronary atherosclerotic disease to better predict post-interventional physiological outcomes, and thereby identify the appropriate revascularization target. Pre-interventional pullback tracings with dedicated post-processing methods can provide characterization of focal versus diffuse disease or major gradient versus minor gradient stenosis, which would result in different post-interventional physiological results. This review provides a comprehensive look at the current evidence regarding the evolving role of physiological assessment as a functional optimization tool for the entire process of revascularization, and not merely as a pre-interventional tool for revascularization decision-making.