Physiology Guided Percutaneous Coronary Intervention: Basics, Evolution and Clinical Application

Chee Yang Chin1

  • 1National Heart Centre Singapore

Details

08:45 - 09:00 | Wed 24 Jul | M4 - Level 3 | WeA11.2

Session: Challenges and Opportunities of Cardiac Imaging and Advanced Data Analysis in Cardiovascular Disease

Abstract

Percutaneous coronary intervention (PCI) guidance has evolved from a subjective, visually-guided approach to a more objective, physiology-guided one. Invasive guidewire-based physiological measurements have become on-the-spot, table-side tools for clinical decision making. It follows that the technology involved has progressed to allow more robust, high fidelity measurements to be made. A systematic review of the literature was conducted and landmark papers in coronary physiology identified. Major landmark trials in the last 2 decades have confirmed the utility of coronary blood flow and pressure measurements in assessing the functional importance of coronary artery stenoses, and in predicting the clinical outcomes of patients with and without PCI. Fractional flow reserve (FFR) guided PCI has been shown to improve clinical outcomes versus angiography guidance alone. Further refinements in coronary physiology assessment include resting indices such as the instantaneous wave free ratio (iFR), which negate the use of hyperaemic agents, thus reducing procedure time and improving patient comfort. iFR-guided PCI has been proven to be equivalent to FFR-guided PCI in terms of clinical outcomes. The success and global uptake of iFR has led to the proliferation of a host of other resting indices with similar performance and outcomes. Invasive coronary physiology assessment provides objective, reliable, reproducible assessments of coronary artery disease severity. Having a simple bedside tool that aids decision making helps physicians make the correct clinical decisions for each patient. Refinements in guidewire technology will improve ease of use for the interventional cardiologist, whilst reducing the potential of harm to the patient. Further development in physiology indices may eventually lead to the discovery of the “ideal” physiological index that combines accuracy, ease of use, affordability, availability and safety.