National Heart and Lung Institute, Imperial College London, London, United Kingdom.
EuroIntervention. 2021 Apr 2;16(18):e1470-e1483. doi: 10.4244/EIJ-D-20-00988.
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have persistence or recurrence of angina after angiographically successful percutaneous coronary intervention (PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
在当代稳定型冠状动脉疾病管理指南中，采用有创冠状动脉生理学方法选择患者进行冠状动脉血运重建已经得到确立。与仅基于血管造影的血运重建相比，冠状动脉生理学的应用已被证明可以改善临床结果和成本效益。然而，最近来自随机对照试验的数据对缺血检测选择血运重建患者的价值提出了质疑。重要的是，经血管造影成功的经皮冠状动脉介入治疗（PCI）后，仍有 20-40%的患者存在心绞痛持续或复发。本综述重点介绍了有创冠状动脉生理学从作为固定切点的缺血二分类检测方法向实时指导 PCI 以优化生理学结果的应用的转变作用。我们总结了稳定型冠状动脉疾病中缺血检测的当代证据基础，检查了允许先进的 PCI 生理学指导的新兴指标，并讨论了 PCI 后生理学评估的基本原理和证据基础，以评估血运重建的效果。
