Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology

Javier Escaned, Colin Berry, Bernard De Bruyne, Asad Shabbir, Carlos Collet, Joo Myung Lee, Yolande Appelman, Emanuele Barbato, Simone Biscaglia, Piotr P. Buszman, Gianluca Campo, Alaide Chieffo, Róisín Colleran, Damien Collison, Justin Davies, Daniele Giacoppo, Niels R. Holm, Allen Jeremias, Valeria Paradies, Zsolt PiróthLuís Raposo, Ariel Roguin, Tanja Rudolph, Giovanna Sarno, Sayan Sen, Gabor G. Toth, Eric Van Belle, Frederik M. Zimmermann, Dariusz Dudek, Giulio Stefanini, Giuseppe Tarantini

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.

Original languageEnglish
Pages (from-to)464-481
Number of pages18
JournalEuroIntervention
Volume19
Issue number6
DOIs
StatePublished - 2023
Externally publishedYes

Keywords

  • fractional flow reserve
  • intravascular ultrasound
  • non-invasive imaging

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