Author + information
- Received September 26, 1996
- Revision received May 27, 1997
- Accepted May 30, 1997
- Published online July 1, 1997.
- ↵*Dr. Morton J. Kern, J. G. Mudd Cardiac Catheterization Laboratory, Saint Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, Saint Louis, Missouri 63110.
Decisions regarding coronary interventions should be combined with objective evidence of myocardial ischemia. The most common physiologic approach utilizes hospital facilities outside the catheterization laboratory, requiring additional time and cost. With the introduction of sensor-tipped angioplasty guide wires, distal coronary flow velocity and pressure can be obtained in the cardiac catheterization laboratory, facilitating physiologically based decisions regarding the need for intervention. In the catheterization laboratory, physiologically significant stenoses can be characterized as having impaired post-stenotic coronary flow reserve <2.0 and pressure-derived fractional flow reserve <0.75, both variables related strongly to positive ischemic perfusion imaging or stress testing results. Deferring coronary interventions on the basis of normal translesional physiology is safe and is associated with a low rate (<10%) of lesion progression over a 10-month follow-up period. Preliminary data indicate that excellent physiologic and anatomic end points after balloon angioplasty are associated with low (<20%) restenosis rates at 6-month follow-up. Clinically relevant relations of in-laboratory physiology support the insight that physiologic, as much as or more than anatomic variables, ultimately determine the functional status of a patient. Current data suggest that an intracoronary physiologic approach complements coronary lumenology and appears to have important clinical and economic implications for patients undergoing invasive evaluation and treatment of coronary artery disease.
- Received September 26, 1996.
- Revision received May 27, 1997.
- Accepted May 30, 1997.
- 1 The Problem: Moving Beyond Lumenology
- 2 Development of Coronary Physiology for the Catheterization Laboratory
- 3 Safety, Reliability and Reproducibility
- 4 Clinical Considerations to Using Coronary Physiology in Patients With Coronary Artery Disease
- 5 Clinical Studies: Translesional Hemodynamic Variables as a Surrogate for Ischemic Stress Testing
- 6 Translesional Hemodynamic Data and Clinical Outcomes
- 7 Physiologic Decision Making During Diagnostic Catheterization
- 8 Expense of Physiologic Data
- 9 Physiologically Guided Angioplasty
- 10 Pressure Versus Flow
- 11 Summary
- Appendix A