Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Functional Approach for Coronary Artery Disease: Filling the Gap Between Evidence and Practice

  • Lee, Joo Myung (Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Doh, Joon-Hyung (Department of Medicine, Inje University Ilsan Paik Hospital) ;
  • Nam, Chang-Wook (Department of Medicine, Keimyung University Dongsan Medical Center) ;
  • Shin, Eun-Seok (Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Koo, Bon-Kwon (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital)
  • Received : 2017.12.28
  • Accepted : 2018.01.25
  • Published : 2018.03.19
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Abstract

The presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease, and ischemia-directed revascularization has been a standard of care. Fractional flow reserve (FFR) is an invasive method used to detect the functionally significant epicardial coronary stenosis, and FFR-guided revascularization strategy has been proven to be superior to angiography-guided strategy. Recently, a hyperemia-free index, instantaneous wave free ratio (iFR), was developed and showed its non-inferiority for clinical outcomes compared with FFR-guided strategy. While evidence supporting the benefit of pressure wire assessment exists, there remain several unresolved issues, such as the mechanism of discordance between resting and hyperemic physiologic indices, clinical outcomes of patient/lesions with discordant results among the physiologic indices, role of physiologic indices beyond per-vessel decision tool, and the role of microvascular dysfunction in patient prognosis. The current article will review the recent studies performed to address these questions.

Keywords

References

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