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Review
. 2021 Feb 8;14(3):237-246.
doi: 10.1016/j.jcin.2020.10.055.

Invasive Coronary Physiology After Stent Implantation: Another Step Toward Precision Medicine

Simone Biscaglia  1 , Barry Uretsky  2 , Emanuele Barbato  3 , Carlos Collet  4 , Yoshinobu Onuma  5 , Allen Jeremias  6 , Matteo Tebaldi  3 , Abdul Hakeem  7 , Norihiro Kogame  8 , Jeroen Sonck  9 , Javier Escaned  10 , Patrick W Serruys  11 , Gregg W Stone  12 , Gianluca Campo  13
Affiliations
Free article
Review

Invasive Coronary Physiology After Stent Implantation: Another Step Toward Precision Medicine

Simone Biscaglia et al. JACC Cardiovasc Interv. .
Free article

Abstract

Intracoronary physiology is routinely used in setting the indication for percutaneous coronary intervention (PCI) but seldom in assessing procedural results. This attitude is increasingly challenged by accumulated evidence demonstrating the value of post-PCI functional assessment in predicting long-term patient outcomes. Besides fractional flow reserve, a number of new indexes recently incorporated to clinical practice, including nonhyperemic pressure and functional angiographic indexes, provide new opportunities for the physiological assessment of PCI results. Largely, the benefit of these tools is derived from longitudinal analysis of the treated vessel, which allows precise identification of the vessel segment accounting for a suboptimal functional result and enabling operators to perform accurate PCI optimization. In this document the authors review available evidence supporting why physiological assessment should be extended to immediate post-PCI with the aim of improving patient outcomes. A step-by-step guide on how available physiological tools can be used for such purpose is provided.

Keywords: coronary physiology; fractional flow reserve; instantaneous wave-free ratio; outcome; percutaneous coronary intervention; precision medicine; quantitative flow ratio.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Biscaglia has received research grants from Medis, SMT, and Siemens. Dr. Campo has received research grants from Boston Scientific, Medis, SMT, and Siemens. Dr. Tebaldi has received a research grant from Boston Scientific. Dr. Barbato has received speaker fees from Abbott Vascular, Boston Scientific, and GE. Dr. Uretsky has received a research grant from Opsens. Dr. Serruys has received personal fees from Sino Medical Sciences Technology, Philips/Volcano, and Xeltis. Dr. Sonck has received a research grant from the CardioPath PhD program. Dr. Collet has received consultancy fees from HeartFlow, Opsens, Biosensors, Boston Scientific, Philips/Volcano, and Abbott Vascular; and has received research grants from HeartFlow, Abbott Vascular, and ShockWave Medical. Dr. Stone has received speaker or other honoraria from Cook, Terumo, Qool Therapeutics, and Orchestra Biomed; has served as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, and Matrizyme; and has equity or options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, the Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, the MedFocus family of funds, and Valfix. Dr. Jeremias has received institutional grants and consulting fees from Abbott Vascular and Philips/Volcano; and is a consultant for ACIST and Boston Scientific. Dr. Escaned has received consulting and/or speaker fees from Abbott, Boston Scientific, Opsens, and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.