Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory

• Published in: Journal of the American College of Cardiology Vol. 55; no. 3; pp. 173 - 185
• Main Authors: Kern, Morton J., MD, Samady, Habib, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 19.01.2010; Elsevier; Elsevier Limited
• Subjects: Anatomy & physiology; angiography; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; coronary stenoses; Coronary vessels; Flow velocity; Fractional Flow Reserve, Myocardial - physiology; Heart; Heart attacks; Humans; Internal Medicine; Intubation; Ischemia; Medical imaging; Medical sciences; Patient Selection; physiology; Predictive Value of Tests; severity; Survival Analysis; coronary artery disease; major adverse cardiac events; myocardial infarction; Thrombolysis In Myocardial Infarction; angiography; CFR; aortic pressure; SPECT; Pa; percutaneous coronary intervention; acute coronary syndrome; FFR; Pd; MACE; MI; fractional flow reserve; coronary artery bypass grafting; severity; coronary stenoses; CAD; mean pressure distal to a stenosis; physiology; QCA; catheterization laboratory; ACS; quantitative coronary angiography; coronary flow reserve; TIMI; PCI; Cath lab; CABG; single-photon emission computed tomography; Concept; Catheterization; Coronary artery; Cardiovascular disease; Physiology; Circulatory system; Laboratory; Cardiology; Coronary heart disease; Current
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.06.062

Over the last 15 years, the use of invasive coronary physiology in the catheterization laboratory has demonstrated favorable outcomes for decision making in patients with intermediate single-vessel stenoses, complex bifurcation and ostial branch stenoses, multivessel coronary artery disease, and left main stenoses. A recent large multicenter study (FAME [FFR versus Angiography for Multivessel Evaluation]) found that a physiologically-guided approach was superior to the standard angiographically-guided approach for percutaneous revascularization in patients with multivessel coronary artery disease. This review addresses selected pertinent concepts and studies supporting the integration of coronary physiology in the catheterization laboratory for optimal patient outcomes.