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Korean J Intern Med. 2013 Jan;28(1):1-7. doi: 10.3904/kjim.2013.28.1.1. Epub 2012 Dec 28.

Physiologic approach for coronary intervention.

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  • 1Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 94305, USA. wfearon@stanford.edu

Abstract

When invasively assessing coronary artery disease, the primary goal should be to determine whether the disease is causing a patient's symptoms and whether it is likely to cause future cardiac events. The presence of myocardial ischemia is our best gauge of whether a lesion is responsible for symptoms and likely to result in a future cardiac event. In the catheterization laboratory, fractional flow reserve (FFR) measured with a coronary pressure wire is the reference standard for identifying ischemia-producing lesions. Its spatial resolution is unsurpassed with it not only being vessel-specific, but also lesion-specific. There is now a wealth of data supporting the accuracy of measuring FFR to identify ischemia-producing lesions. FFR-guided percutaneous coronary intervention of these lesions results in improved outcomes and saves resources. Non-hemodynamically significant lesions can be safely managed medically with a low rate of subsequent cardiac events.

KEYWORDS:

Coronary disease; Coronary physiology

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