Hwang Doyeon, Yang Seokhun, Zhang Jinlong, Koo Bon Kwon
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Korean Circ J. 2021 Mar;51(3):189-201. doi: 10.4070/kcj.2020.0548.
The presence of myocardial ischemia is a prerequisite for the benefit of coronary revascularization. In the cardiac catheterization laboratory, fractional flow reserve and non-hyperemic pressure ratios are used to define the ischemia-causing coronary stenosis, and several randomized studies showed the benefit of physiology-guided coronary revascularization. However, physiology-guided revascularization does not necessarily guarantee the relief of ischemia. Recent studies reported that residual ischemia might exist in up to 15-20% of cases after angiographically successful percutaneous coronary intervention (PCI). Therefore, post-PCI physiologic assessment is necessary for judging the appropriateness of PCI, detecting the lesions that may benefit from additional PCI, and risk stratification after PCI. This review will focus on the current evidence for post-PCI physiologic assessment, how to interpret these findings, and the future perspectives of physiologic assessment after PCI.
心肌缺血的存在是冠状动脉血运重建获益的前提条件。在心脏导管实验室中，血流储备分数和非充血压力比值用于定义导致缺血的冠状动脉狭窄，多项随机研究显示了生理学指导下冠状动脉血运重建的益处。然而，生理学指导下的血运重建并不一定能保证缺血得到缓解。最近的研究报道，在血管造影成功的经皮冠状动脉介入治疗（PCI）后，高达15%-20%的病例可能存在残余缺血。因此，PCI术后的生理学评估对于判断PCI的适宜性、检测可能从额外PCI中获益的病变以及PCI后的风险分层是必要的。本综述将聚焦于PCI术后生理学评估的当前证据、如何解读这些发现以及PCI后生理学评估的未来展望。
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