STATE-OF-THE-ART PAPER
Current Concepts of Integrated Coronary Physiology in the Catheterization Laboratory
Morton J. Kern, MD*,* and
Habib Samady, MD
* University of California, Irvine, California
Emory University, Atlanta, Georgia
Manuscript received April 23, 2009;
revised manuscript received May 28, 2009,
accepted June 9, 2009.
* Reprint requests and correspondence: Dr. Morton J. Kern, Division of Cardiology, University of California, Irvine, 333 West City Tower Drive, Suite 400, Room 407, Orange, California 92868-4080 (Email: mkern{at}uci.edu).
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.
Key Words: angiography • coronary stenoses • severity • physiology
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Abbreviations and Acronyms
| | ACS = acute coronary syndrome | | CABG = coronary artery bypass grafting | | CAD = coronary artery disease | | Cath lab = catheterization laboratory | | CFR = coronary flow reserve | | FFR = fractional flow reserve | | MACE = major adverse cardiac events | | MI = myocardial infarction | | Pa = aortic pressure | | PCI = percutaneous coronary intervention | | Pd = mean pressure distal to a stenosis | | QCA = quantitative coronary angiography | | SPECT = single-photon emission computed tomography | | TIMI = Thrombolysis In Myocardial Infarction |
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