Clinical Scorecard: Current Developments in Percutaneous Coronary Intervention: Enhancing Coronary Physiology-Guided and Device-Driven Approaches for Revascularization

At a Glance

Key Highlights

• PCI has evolved into a precision-based strategy integrating coronary physiology, imaging, and advanced device technologies.
• Physiology-guided PCI improves lesion selection but has limitations in complex and post-CABG disease.
• Advances in drug-eluting stents, intravascular imaging, and adjunctive technologies have expanded PCI indications.
• Evidence-based, anatomy- and physiology-driven decision-making remains essential for optimal revascularization.
• Emerging device and biologic innovations highlight future directions in coronary intervention.

Guideline-Based Recommendations

Diagnosis

• Utilization of fractional flow reserve (FFR) for physiological guidance in coronary stenosis.

Management

• Adoption of non-hyperemic coronary pressure measurements as alternatives to FFR.

Monitoring & Follow-up

• Continuous evaluation of procedural outcomes and patient survival post-PCI.

Risks

• Limitations of physiology-guided PCI in complex and post-CABG disease.

Patient & Prescribing Data

Patients with coronary artery disease undergoing PCI.

Integration of advanced imaging and device technologies to enhance procedural precision.

Clinical Best Practices

• Implement evidence-based, anatomy- and physiology-driven decision-making for revascularization.
• Utilize advanced intravascular imaging to optimize PCI outcomes.
• Consider emerging technologies such as drug-coated balloons and resorbable scaffolds.

References

• European Society of Cardiology Guidelines on Myocardial Revascularization