Physiology-Based Revascularization of Left Main Coronary Artery Disease

J Interv Cardiol. 2021 Feb 10:2021:4218769. doi: 10.1155/2021/4218769. eCollection 2021.

Abstract

It is of critical importance to correctly assess the significance of a left main lesion. Underestimation of significance beholds the risk of inappropriate deferral of revascularization, whereas overestimation may trigger major but unnecessary interventions. This article addresses the invasive physiological assessment of left main disease and its role in deciding upon revascularization. It mainly focuses on the available evidence for fractional flow reserve and instantaneous wave-free ratio, their interpretation, and limitations. We also discuss alternative invasive physiological indices and imaging, as well as the link between physiology, ischemia, and prognosis.

Publication types

  • Review

MeSH terms

  • Coronary Artery Disease* / physiopathology
  • Coronary Artery Disease* / therapy
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / physiopathology
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Myocardial Ischemia* / etiology
  • Myocardial Ischemia* / prevention & control
  • Myocardial Revascularization* / adverse effects
  • Myocardial Revascularization* / methods
  • Predictive Value of Tests
  • Prognosis
  • Risk Adjustment / methods