Does Coronary Flow Trump Coronary Anatomy? | Zendy

K. Lance Gould | Zendy

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Does Coronary Flow Trump Coronary Anatomy?

Author(s) -

K. Lance Gould

Publication year - 2009

Publication title -

jacc. cardiovascular imaging

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 5.79

H-Index - 120

eISSN - 1936-878X

pISSN - 1876-7591

DOI - 10.1016/j.jcmg.2009.06.004

Subject(s) - cardiology , fractional flow reserve , conventional pci , medicine , coronary artery disease , stenosis , revascularization , coronary flow reserve , percutaneous coronary intervention , coronary anatomy , coronary circulation , blood flow , myocardial infarction , coronary angiography

Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous intervention (PCI) guided by fractional flow reserve reduces coronary events more than PCI guided by arteriographic stenosis. These paradoxes are explained by the poor relation between coronary flow reserve (CFR) and stenosis severity due to diffuse CAD, with surprising clinical implications. Should the concept of anatomically "critical" coronary stenosis be replaced by the concept of "critical" CFR reduction for managing CAD?

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