Abdul Rahman Ihdayhid1, Jin-Sin Koh2,3, John Ramzy1, Arnav Kumar3, Michael Michail1,4, Adam Brown1, Habib Samady5,6. 1. Monash Cardiovascular Research Centre and MonashHeart, Monash University and Monash Health, Melbourne, Australia. 2. Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. 3. Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Suite F606, Atlanta, GA, 30322, USA. 4. Institute of Cardiovascular Science, University College London, London, UK. 5. Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. hsamady@emory.edu. 6. Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Suite F606, Atlanta, GA, 30322, USA. hsamady@emory.edu.
Abstract
PURPOSE OF REVIEW: The role of fractional flow reserve to guide revascularization in patients with stable angina is well established. The instantaneous wave-free ratio (iFR) is an emerging adenosine-free resting index that is non-inferior to FFR and has potential to streamline the functional evaluation of coronary artery disease. The feasibility and utility of intracoronary physiology in patients with acute coronary syndrome (ACS) is unclear. This review will discuss the physiological principles and validity of using FFR and iFR in patients presenting with ACS. We will also provide an overview of the available evidence for their role in guiding revascularization in this patient group. RECENT FINDINGS: The use of intracoronary physiology in culprit lesions of patients presenting with STEMI is not recommended and its accuracy is uncertain in patients with NSTEMI. In contrast, the physiological assessment of non-culprit vessels with FFR and IFR is a reliable measure of lesion-specific ischemia. Recent studies have demonstrated that FFR-guided revascularization of non-culprit lesions improves clinical outcomes although the role of iFR in this patient cohort is unknown. Physiology-guided revascularization of non-culprit ACS lesions improves clinical outcomes. Future studies investigating the complementary role of plaque morphology, biomechanics, and systemic inflammation may provide clinicians with a more comprehensive framework to guide treatment decisions.
PURPOSE OF REVIEW: The role of fractional flow reserve to guide revascularization in patients with stable angina is well established. The instantaneous wave-free ratio (iFR) is an emerging adenosine-free resting index that is non-inferior to FFR and has potential to streamline the functional evaluation of coronary artery disease. The feasibility and utility of intracoronary physiology in patients with acute coronary syndrome (ACS) is unclear. This review will discuss the physiological principles and validity of using FFR and iFR in patients presenting with ACS. We will also provide an overview of the available evidence for their role in guiding revascularization in this patient group. RECENT FINDINGS: The use of intracoronary physiology in culprit lesions of patients presenting with STEMI is not recommended and its accuracy is uncertain in patients with NSTEMI. In contrast, the physiological assessment of non-culprit vessels with FFR and IFR is a reliable measure of lesion-specific ischemia. Recent studies have demonstrated that FFR-guided revascularization of non-culprit lesions improves clinical outcomes although the role of iFR in this patient cohort is unknown. Physiology-guided revascularization of non-culprit ACS lesions improves clinical outcomes. Future studies investigating the complementary role of plaque morphology, biomechanics, and systemic inflammation may provide clinicians with a more comprehensive framework to guide treatment decisions.
Authors: B De Bruyne; N H Pijls; J Bartunek; K Kulecki; J W Bech; H De Winter; P Van Crombrugge; G R Heyndrickx; W Wijns Journal: Circulation Date: 2001-07-10 Impact factor: 29.690
Authors: Holger Thiele; Ibrahim Akin; Marcus Sandri; Georg Fuernau; Suzanne de Waha; Roza Meyer-Saraei; Peter Nordbeck; Tobias Geisler; Ulf Landmesser; Carsten Skurk; Andreas Fach; Harald Lapp; Jan J Piek; Marko Noc; Tomaž Goslar; Stephan B Felix; Lars S Maier; Janina Stepinska; Keith Oldroyd; Pranas Serpytis; Gilles Montalescot; Olivier Barthelemy; Kurt Huber; Stephan Windecker; Stefano Savonitto; Patrizia Torremante; Christiaan Vrints; Steffen Schneider; Steffen Desch; Uwe Zeymer Journal: N Engl J Med Date: 2017-10-30 Impact factor: 91.245
Authors: Antonio Maria Leone; Alberto Ranieri De Caterina; Eloisa Basile; Andrea Gardi; Domenico Laezza; Mario Attilio Mazzari; Rocco Mongiardo; Rajesh Kharbanda; Florim Cuculi; Italo Porto; Giampaolo Niccoli; Francesco Burzotta; Carlo Trani; Adrian Paul Banning; Antonio Giuseppe Rebuzzi; Filippo Crea Journal: Circ Cardiovasc Interv Date: 2013-01-15 Impact factor: 6.546
Authors: Amir Halkin; Mandeep Singh; Eugenia Nikolsky; Cindy L Grines; James E Tcheng; Eulogio Garcia; David A Cox; Mark Turco; Thomas D Stuckey; Yingo Na; Alexandra J Lansky; Bernard J Gersh; William W O'Neill; Roxana Mehran; Gregg W Stone Journal: J Am Coll Cardiol Date: 2005-05-03 Impact factor: 24.094
Authors: Borja Ibanez; Stefan James; Stefan Agewall; Manuel J Antunes; Chiara Bucciarelli-Ducci; Héctor Bueno; Alida L P Caforio; Filippo Crea; John A Goudevenos; Sigrun Halvorsen; Gerhard Hindricks; Adnan Kastrati; Mattie J Lenzen; Eva Prescott; Marco Roffi; Marco Valgimigli; Christoph Varenhorst; Pascal Vranckx; Petr Widimský Journal: Eur Heart J Date: 2018-01-07 Impact factor: 29.983
Authors: Thomas Engstrøm; Henning Kelbæk; Steffen Helqvist; Dan Eik Høfsten; Lene Kløvgaard; Lene Holmvang; Erik Jørgensen; Frants Pedersen; Kari Saunamäki; Peter Clemmensen; Ole De Backer; Jan Ravkilde; Hans-Henrik Tilsted; Anton Boel Villadsen; Jens Aarøe; Svend Eggert Jensen; Bent Raungaard; Lars Køber Journal: Lancet Date: 2015-08-15 Impact factor: 79.321
Authors: Hernán Mejía-Rentería; Joo Myung Lee; Nina W van der Hoeven; Nieves Gonzalo; Pilar Jiménez-Quevedo; Luis Nombela-Franco; Iván J Núñez-Gil; Pablo Salinas; María Del Trigo; Enrico Cerrato; Niels van Royen; Paul Knaapen; Bon-Kwon Koo; Carlos Macaya; Antonio Fernández-Ortiz; Javier Escaned Journal: J Am Heart Assoc Date: 2019-05-07 Impact factor: 5.501
Authors: Allen Jeremias; Akiko Maehara; Philippe Généreux; Kaleab N Asrress; Colin Berry; Bernard De Bruyne; Justin E Davies; Javier Escaned; William F Fearon; K Lance Gould; Nils P Johnson; Ajay J Kirtane; Bon-Kwon Koo; Koen M Marques; Sukhjinder Nijjer; Keith G Oldroyd; Ricardo Petraco; Jan J Piek; Nico H Pijls; Simon Redwood; Maria Siebes; Jos A E Spaan; Marcel van 't Veer; Gary S Mintz; Gregg W Stone Journal: J Am Coll Cardiol Date: 2013-11-06 Impact factor: 24.094
Authors: Jamie Layland; Keith G Oldroyd; Nick Curzen; Arvind Sood; Kanarath Balachandran; Raj Das; Shahid Junejo; Nadeem Ahmed; Matthew M Y Lee; Aadil Shaukat; Anna O'Donnell; Julian Nam; Andrew Briggs; Robert Henderson; Alex McConnachie; Colin Berry Journal: Eur Heart J Date: 2014-09-01 Impact factor: 29.983
Authors: Michael Michail; Udit Thakur; Ojas Mehta; John M Ramzy; Andrea Comella; Abdul Rahman Ihdayhid; James D Cameron; Stephen J Nicholls; Stephen P Hoole; Adam J Brown Journal: Open Heart Date: 2020-10