Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India  

作　　者：Sridhar Kasturi Ramneek Kaur Manish Narang Surinder Kher Sridhar Kasturi;Ramneek Kaur;Manish Narang;Surinder Kher(Department of Cardiology, Sunshine Heart Institute, Secunderabad, Hyderabad, India;Department of Medical Affairs, Abbott Vascular, Abbott Healthcare Pvt Ltd., Delhi, India;Asia Pacific & Japan, Department of Medical Affairs, Abbott Vascular, Abbott Healthcare Pvt Ltd., Delhi, India;Independent Clinical Research Professional, Bangalore, India)

机构地区：[1]Department of Cardiology, Sunshine Heart Institute, Secunderabad, Hyderabad, India [2]Department of Medical Affairs, Abbott Vascular, Abbott Healthcare Pvt Ltd., Delhi, India [3]Asia Pacific & Japan, Department of Medical Affairs, Abbott Vascular, Abbott Healthcare Pvt Ltd., Delhi, India [4]Independent Clinical Research Professional, Bangalore, India

出　　处：《World Journal of Cardiovascular Diseases》2023年第11期795-810,共16页心血管病（英文）

摘　　要：Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

关 键 词：Coronary Physiology Fractional Flow Reserve Percutaneous Coronary Intervention REVASCULARIZATION 

分 类 号：R54[医药卫生—心血管疾病]