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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

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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