Does Coronary Flow Trump Coronary Anatomy?

Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous interven...

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Veröffentlicht in:	JACC. Cardiovascular imaging 2009-08, Vol.2 (8), p.1009-1023
1. Verfasser:	Gould, K. Lance, MD
Format:	Artikel
Sprache:	eng
Schlagworte:	Aged Angioplasty, Balloon, Coronary Animals Cardiovascular Coronary Angiography Coronary Circulation Coronary Stenosis - diagnosis Coronary Stenosis - diagnostic imaging Coronary Stenosis - physiopathology Coronary Stenosis - therapy Critical Illness Fractional Flow Reserve, Myocardial Humans Male Myocardial Perfusion Imaging - methods Patient Selection Positron-Emission Tomography Predictive Value of Tests Severity of Illness Index Terminology as Topic Tomography, Emission-Computed, Single-Photon Treatment Outcome
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Zusammenfassung:	Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous intervention (PCI) guided by fractional flow reserve reduces coronary events more than PCI guided by arteriographic stenosis. These paradoxes are explained by the poor relation between coronary flow reserve (CFR) and stenosis severity due to diffuse CAD, with surprising clinical implications. Should the concept of anatomically “critical” coronary stenosis be replaced by the concept of “critical” CFR reduction for managing CAD?
ISSN:	1936-878X 1876-7591
DOI:	10.1016/j.jcmg.2009.06.004