Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization

Numerous evidence exists supporting the prognostic values of post-PCI physiologic assessment and its role in functionally optimized PCI. Post-PCI physiologic assessment would be particularly important, as a substantial proportion of patients who underwent angiographically successful PCI had evidence of residual ischemia manifested by suboptimal post-PCI FFR or NHPRs which were associated with worse clinical outcomes. Considering that the purpose of PCI is not just to alleviate angiographic stenosis but to resolve myocardial ischemia and improve prognosis, it is crucial to investigate the causes of suboptimal post-PCI physiologic results using pressure-wire pullback tracings and/or intravascular imaging. If there is a focal step-up in pullback tracings, additional optimization procedures will be required to achieve functionally optimized PCI. It is also important to note that functionally optimized PCI should be considered at the beginning of the procedure, as careful PCI planning using pre-PCI physiologic evaluation can increase the probability of functionally optimized PCI. Ongoing clinical trials will answer the remaining question regarding whether pre-PCI planning guided by pullback analysis and additional optimization procedures guided by post-PCI physiologic assessment will improve outcomes.38

Automated summary

Post-PCI physiologic assessment has significant prognostic value and plays a role in functionally optimized PCI. Investigating the reasons behind suboptimal post-PCI physiologic results using pressure-wire pullback tracings and/or intravascular imaging is important. Functionally optimized PCI should be considered at the beginning of the procedure, and careful PCI planning using pre-PCI physiologic evaluation can increase the probability of achieving it.