Integrated Coronary Physiology in Percutaneous Intervention: A new paradigm in interventional cardiology - 16/09/11

Doi : 10.1016/j.hlc.2010.08.017

J. Layland, FRACP ^a,^b,^⁎ , A.M. MacIsaac, MD, FRACP ^a,^b, A.T. Burns, MD, FRACP ^a,^b, R.J. Whitbourn, FRACP ^a,^b, A.M. Wilson, PhD, FRACP ^a,^b,^c
^a Cardiovascular Research Centre, St. Vincent’s Hospital, Melbourne, Victoria, Australia
^b University of Melbourne, Parkville, Melbourne, Victoria, Australia
^c Epworth Heart Centre, Richmond, Melbourne, Victoria, Australia

Corresponding author at: Department of Cardiology, St Vincent’s Hospital, Melbourne, Victoria, Australia. Tel.: +61 3 9288 2211; fax: +61 3 988 4422.

Résumé

Coronary angiography has provided an unrivalled appreciation of coronary anatomy fostering a far greater appreciation of the extent of atherosclerotic disease. However, the subjectivity of coronary angiography at determining the extent of plaque has been exposed with IVUS. Indices of coronary physiology have provided valuable adjunctive information as to the physiological importance of specific lesions. Fractional flow reserve is an established method for evaluating the significance of epicardial stenoses. Fractional flow reserve guided percutaneous coronary intervention is associated with improved outcomes when compared to a conventional angiographic guided strategy, particularly in intermediate lesions. The use of coronary physiology in the cath lab represents a new avenue to guide appropriate patient specific revascularisation strategies. This review examines the theory and evidence for fractional flow reserve and its use in percutaneous coronary intervention.

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Keywords : Fractional flow reserve, Percutaneous coronary intervention, Physiology