What is the Role of Coronary Physiology in the Management of Patients with Chronic Coronary Syndromes?

The use of coronary physiology in patients with chronic coronary syndromes is highly variable, and the evidence base complex. Tests of coronary physiology have traditionally been invasive (e.g., fractional flow reserve), but novel non-invasive methods are now available which provide additional anatomical information (e.g., computed tomography-based fractional flow reserve and angiogram-derived physiology). This review summarises the evidence for and against the relative value of these tests for patients being investigated for chest pain that may represent chronic coronary syndromes, and for those triaged to percutaneous coronary intervention.