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Review
. 2023 Sep 12;3(6):825-842.
doi: 10.1016/j.jacasi.2023.07.004. eCollection 2023 Dec.

Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 2

Bon-Kwon Koo  1 , Doyeon Hwang  1 , Sungjoon Park  1 , Shoichi Kuramitsu  2 , Taishi Yonetsu  3 , Chee Hae Kim  4 , Jinlong Zhang  5 , Seokhun Yang  1 , Joon-Hyung Doh  6 , Young-Hoon Jeong  7 , Ki Hong Choi  8 , Joo Myung Lee  8 , Jung-Min Ahn  9 , Hitoshi Matsuo  10 , Eun-Seok Shin  11 , Xinyang Hu  5 , Adrian F Low  12 , Takashi Kubo  13 , Chang-Wook Nam  14 , Andy S C Yong  15 , Scott A Harding  16 , Bo Xu  17 , Seung-Ho Hur  14 , Gim Hooi Choo  18 , Huay Cheem Tan  12 , Ajit Mullasari  19 , I-Chang Hsieh  20 , Tsunekazu Kakuta  21 , Takashi Akasaka  22 , Jian'an Wang  5 , Seung-Jea Tahk  23 , William F Fearon  24 , Javier Escaned  25 , Seung-Jung Park  9
Affiliations
Review

Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 2

Bon-Kwon Koo et al. JACC Asia. .

Abstract

Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of clinical data that has led to major recommendations in all practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region, based on updated information in the field that includes both wire- and image-based physiologic assessment. This is Part 2 of the whole consensus document, which provides theoretical and practical information on physiologic indexes for specific clinical conditions and patient statuses.

Keywords: Asia-Pacific; coronary artery disease; coronary physiologic assessment.

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Conflict of interest statement

This work is supported by the grant from the Patient-Centered Clinical Research Coordinating Center (grant number HC19C0305). Dr Koo has received Institutional Research Grants from Abbott Vascular, Boston Scientific, Philips, and HeartFlow. Dr Wang has received institutional research grants from Boston Scientific. Dr Harding has received proctoring fees and speaker honoraria from Abbott Vascular, Boston Scientific, Medtronic, and Terumo Medical. Dr Fearon has received institutional research support from Abbott, Boston Scientific, and Medtronic; has consulting relationships with CathWorks and Siemens; and has stock options with HeartFlow. Dr Lee has received institutional research grants from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Zoll Medical, and Donga-ST. Dr Hu has received institutional research grants from Boston Scientific. Dr Yong has received minor honoraria from Abbott Vascular and institutional research grants and support from Abbott Vascular and Philips. Dr Kuramitsu has received lecture fees from Abbott Medical Japan and Boston Scientific Japan. Dr Jeong has received honoraria for lectures from Daiichi Sankyo, Sanofi-Aventis, Han-mi Pharmaceuticals, and JW Pharmaceuticals and research grants or support from Han-mi Pharmaceuticals, Samjin Pharmaceuticals, Yuhan Pharmaceuticals, Biotronik, Dio Medical, and U and I Corporation. Dr Escaned has received personal fees as speaker or advisory board member from Abbott, Boston Scientific, Medis, RainMed, and Philips; he has reported joint ownership of angio-IMR patent. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Physiologic Approach for Coronary Bifurcation Lesions Based on the previous evidence, treatment strategy flow of coronary bifurcation intervention based on angiographic, physiologic, and imaging assessments is suggested. Reprinted with permission from the Central Illustration in J Am Coll Cardiol Intv. 2022;15(13):1297-1309. FFR = fractional flow reserve; IVUS = intravascular ultrasound; MV = main vessel; NHPR = nonhyperemic pressure ratio; OCT = optical coherence topography; SB = side branch.
Figure 2
Figure 2
Discordance Between Anatomic and Physiologic Severity in Coronary Bifurcation Lesions Discordance between angiographic and physiologic severities has been reported in about 30% to 40% of coronary stenosis. The distribution of mismatch (angiographic diameter stenosis >50% and FFR ≥0.80, orange) and reverse mismatch (diameter stenosis ≤50% and FFR <0.80, gray) is different between left main disease and non-left main disease. The reverse mismatch was more frequently observed in left main disease than in non-left main disease. DS = diameter stenosis; FFR = fractional flow reserve.
Figure 3
Figure 3
Physiologic Assessment of Nonculprit Lesion in Patients With ACS Based on the previous evidence, treatment strategy flow of nonculprit lesion treatment in patients with acute coronary syndrome based on invasive physiologic assessment is suggested. ACS = acute coronary syndrome; FFR = fractional flow reserve; NSTEMI = non–ST-segment elevation myocardial infarction; NHPR = nonhyperemic pressure ratio; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction.
Figure 4
Figure 4
FFR-Guided Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease Based on the previous evidence, drug-coated balloon treatment can be performed safely and effectively after successful balloon angioplasty with physiology guidance. DCB = drug-coated balloon; DES = drug-eluting stent(s); FFR = fractional flow reserve.
Figure 5
Figure 5
Diagnosis and Management of INOCA INOCA can be suspected when a coronary angiogram shows no obstructive epicardial arteries and FFR or NHPR is negative in patients with chest pain. Coronary flow is determined by CFR and microvascular resistance, such as IMR. If either the CFR or IMR is abnormal, MVA is diagnosed. VSA is diagnosed based on the response to acetylcholine provocation. INOCA includes patients with MVA, VSA, or both. ACEi = angiotensin-converting enzyme inhibitor; CFR = coronary flow reserve; ECG = electrocardiogram; FFR = fractional flow reserve; INOCA = ischemia with no obstructive coronary artery; IMR = index of microvascular resistance; MVA = microvascular angina; NHPR = nonhyperemic pressure ratio; VSA = vasospastic angina.
See this image and copyright information in PMC

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