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The role of physiology in the contemporary management of coronary artery disease
  1. Francesca Rubino1,2,
  2. Graziella Pompei1,3,
  3. Salvatore Brugaletta4,
  4. Carlos Collet5,
  5. Vijay Kunadian1,6
  1. 1 Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy, Verona, Italy
  3. 3 Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
  4. 4 Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
  5. 5 Cardiovascular Center OLV, Aalst, Belgium
  6. 6 Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  1. Correspondence to Professor Vijay Kunadian, Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, NE2 4HH, UK; vijay.kunadian{at}newcastle.ac.uk

Abstract

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.

  • Coronary Artery Disease
  • Coronary Angiography
  • Percutaneous Coronary Intervention

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Footnotes

  • Twitter @fra_rubi, @VijayKunadian

  • Contributors FR wrote the first draft and undertook multiple revisions. GP contributed to create the figures and provided critical review. CC and SB provided critical review. VK conceived the idea and undertook multiple revisions.

  • Funding VK received research funding from the British Heart Foundation (CS/15/7/31679). The funders had no role in the preparation and decision to publish the manuscript.

  • Competing interests VK is an associate editor for Heart.

  • Provenance and peer review Commissioned; externally peer reviewed.