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KMID : 0368120180480030179
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Korean Circulation Journal
2018 Volume.48 No. 3 p.179 ~ p.190
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Functional Approach for Coronary Artery Disease: Filling the Gap Between Evidence and Practice
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Lee Joo-Myung
Doh Joon-Hyung
Nam Chang-Wook
Shin Eun-Seok
Koo Bon-Kwon
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Abstract
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The presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease, and ischemia-directed revascularization has been a standard of care. Fractional flow reserve (FFR) is an invasive method used to detect the functionally significant epicardial coronary stenosis, and FFR-guided revascularization strategy has been proven to be superior to angiography-guided strategy. Recently, a hyperemia-free index, instantaneous wave free ratio (iFR), was developed and showed its non-inferiority for clinical outcomes compared with FFR-guided strategy. While evidence supporting the benefit of pressure wire assessment exists, there remain several unresolved issues, such as the mechanism of discordance between resting and hyperemic physiologic indices, clinical outcomes of patient/lesions with discordant results among the physiologic indices, role of physiologic indices beyond per-vessel decision tool, and the role of microvascular dysfunction in patient prognosis. The current article will review the recent studies performed to address these questions.
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KEYWORD
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Ischemic heart disease, Coronary artery stenosis, Coronary physiology, Invasive physiologic assessment
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