Does coronary flow trump coronary anatomy?

JACC Cardiovasc Imaging. 2009 Aug;2(8):1009-23. doi: 10.1016/j.jcmg.2009.06.004.


Coronary function versus anatomy, flow versus stenosis: which optimizes coronary artery disease (CAD) management? In patients, coronary flow is poorly related to stenosis severity, and revascularization fails to improve mortality over medical treatment in randomized trials. Yet percutaneous intervention (PCI) guided by fractional flow reserve reduces coronary events more than PCI guided by arteriographic stenosis. These paradoxes are explained by the poor relation between coronary flow reserve (CFR) and stenosis severity due to diffuse CAD, with surprising clinical implications. Should the concept of anatomically "critical" coronary stenosis be replaced by the concept of "critical" CFR reduction for managing CAD?

Publication types

  • Review

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Animals
  • Coronary Angiography*
  • Coronary Circulation*
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / physiopathology
  • Coronary Stenosis / therapy*
  • Critical Illness
  • Fractional Flow Reserve, Myocardial
  • Humans
  • Male
  • Myocardial Perfusion Imaging* / methods
  • Patient Selection
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • Severity of Illness Index
  • Terminology as Topic
  • Tomography, Emission-Computed, Single-Photon
  • Treatment Outcome