Physiologic Lesion Assessment to Optimize Multivessel Disease

• Type of Material: Article
• Authors: Murtaza Bharmal, University of California Irvine; Morton J Kern, University of California Irvine; Gautam Kumar, Emory University; Arnold H Seto, University of California Irvine
• Language: English
• Date: 2022-03-02
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s11886-022-01675-8
• Title of Journal or Parent Work: CURRENT CARDIOLOGY REPORTS
• Volume: 24
• Issue: 5
• Start Page: 541
• End Page: 550
• Keywords: Non-hyperemic pressure ratios; REVASCULARIZATION; CLINICAL-OUTCOMES; DIAGNOSTIC-ACCURACY; Science & Technology; acute coronary syndrome; WAVE-FREE RATIO; Coronary hemodynamics; PERCUTANEOUS CORONARY INTERVENTION; Fractional flow reserve; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; ST-SEGMENT ELEVATION; FOLLOW-UP; Cardiac & Cardiovascular Systems; FRACTIONAL FLOW RESERVE; ARTERY-DISEASE; coronary artery bypass graft; MYOCARDIAL-INFARCTION; Coronary artery disease
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Physiology

Abstract

Purpose of Review: Multivessel coronary artery disease, defined as significant stenosis in two or more major coronary arteries, is associated with high morbidity and mortality. The diagnosis and treatment of multivessel disease have evolved in the PCI era from solely a visual estimation of ischemic risk to a functional evaluation during angiography. This review summarizes the evidence and discusses the commonly used methods of multivessel coronary artery stenosis physiologic assessment. Recent Findings: While FFR remains the gold standard in coronary physiologic assessment, several pressure-wire-based non-hyperemic indices of functional stenosis have been developed and validated as well as wire-free angiographically derived quantitative flow ratio. Identifying and treating functionally significant coronary atherosclerotic lesions reduce symptoms and major adverse cardiovascular events. Summary: Coronary physiologic assessment in multivessel disease minimizes the observer bias in visual estimates of stenosis, changes clinical management, and improves patient outcomes.