Aplicaciones contemporáneas de la fisiología coronaria en distintos escenarios clínicos

Resumen

Although coronary angiography is considered the gold standard in the assessment of ischemic heart disease (IHD), this technique does not provide an accurate information regarding the true physiological relevance of moderate coronary stenosis. In this context, invasive physiological assessment with pressure wires allows an accurate functional stenosis evaluation, and its use is strongly endorsed by the current European clinical guidelines when non-invasive functional tests are not available. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are the two most utilized pressure-wire techniques nowadays, both have been consolidated as the reference techniques for guiding revascularization of moderate and stable coronary lesions in the catheterization laboratories worldwide, and have achieved the highest level of recommendation in the last European guidelines on myocardial revascularization. However, although FFR and iFR have been shown to improve long-term clinical outcomes, there are still pending relevant clinical questions, including their accuracy and safety in certain clinical scenarios such as coronary microcirculatory dysfunction (CMD) and acute myocardial infarction (AMI)...