Coronary Angiography With Pressure Wire and Fractional Flow Reserve State of the Art in the Diagnosis of Coronary Stenosis

Gaede, Luise; Moellmann, Helge; Rudolph, Tanja; Rieber, Johannes; Boenner, Florian und Troebs, Monique (2019): Coronary Angiography With Pressure Wire and Fractional Flow Reserve State of the Art in the Diagnosis of Coronary Stenosis. In: Deutsches Ärzteblatt International, Bd. 116, Nr. 12: S. 205-211

Abstract

Background: Approximately 800 000 coronary angiography procedures are per formed in Germany each year, mainly in order to identify coronary artery stenoses. As a rule, revascularization is indicated only when coronary artery stenoses cause relevant ischemia, but this cannot be determined unequivocally by angiography alone. Pressure wire measurement and the measurement of fractional flow reserve (FFR) enable direct evaluation of the hemodynamic relevance of coronary artery stenoses during diagnostic coronary angiography. Methods: This review is based on publications retrieved by a selective search in PubMed focusing especially on large randomized trials, registry studies, and meta-analyses on either pressure wire measurement or FFR. Results: According to a registry study from France, the hemodynamic evaluation of a stenosis during coronary angiography affected decisions about revascularization in 43% of cases. Randomized multicenter trials have shown that a combined end-point consisting of death, myocardial infarction, or revascularization arose significantly less commonly in the FFR group than in the group receiving angiography without FFR (13.2% versus 18.3%;p = 0.02), and that patients with one or more hemodynamically significant coronary artery stenoses (FFR <= 0.80) benefited more from revascularization than from medical management alone (event rate, 8.1% versus 19.5%;p < 0.001). It was also shown that revascularization yields no benefit if relevant ischemia has been ruled out, even if the angiogram shows high-grade coronary artery stenoses. Conclusion: All cardiac catheter laboratories should be capable of performing pressure wire measurements and measurements of FFR and should do so regularly if ischemia due to coronary artery stenosis cannot be demonstrated non-invasively. A pathological FFR measurement is an indication for revascularization.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1866-0452
• Sprache: Englisch