Ischemia-guided percutaneous coronary intervention for patients with stable coronary artery disease.

Current evidence and guidelines support the strategy of ischemia-guided revascularization for treatment of patients with stable coronary symptoms. However, anatomical stenosis is often targeted in revascularization treatment using percutaneous coronary intervention or coronary artery bypass surgery without seriously considering objective evidence of myocardial ischemia. Particularly, for patients with multivessel disease, angiographic complete revascularization was traditionally considered an ideal objective of revascularization treatment. Recently, however, observational studies contradict the concept of angiographic complete revascularization and support the benefit of ischemia-guided selective revascularization based on noninvasive and invasive functional evaluation detecting ischemia-producing coronary lesions. In the absence of a trial specifically designed to assess the relative benefit of either strategy, the present review explores the current concepts about the strength and weakness of anatomical vs. functional revascularization.