Objective:

To critically examine contemporary advances in PCI, with a strong emphasis on the integration of coronary physiology, intravascular imaging, and next-generation device technologies.

Key Findings:

• PCI has evolved into a precision-based strategy integrating coronary physiology, imaging, and advanced device technologies, leading to improved patient outcomes.
• Physiology-guided PCI improves lesion selection but has limitations in complex and post-CABG disease, necessitating further research.
• Advances in drug-eluting stents, intravascular imaging, and adjunctive technologies have expanded PCI indications, enhancing treatment options.
• Evidence-based, anatomy- and physiology-driven decision-making remains essential for optimal revascularization, particularly in complex cases.
• Emerging device and biologic innovations highlight future directions in coronary intervention, suggesting a need for ongoing clinical trials.

Interpretation:

Contemporary PCI has been transformed by physiology-guided lesion assessment, advanced imaging, and improved stent platforms, enabling safer and more effective treatment of complex coronary anatomy, ultimately improving long-term patient outcomes.

Limitations:

• Adoption of physiology-guided techniques like FFR remains suboptimal in routine practice, indicating a need for educational initiatives.
• Physiology-guided PCI has limitations in multivessel and post-CABG disease, suggesting the need for tailored approaches in these scenarios.

Conclusion:

While technological advances have broadened the scope of PCI and improved procedural outcomes, optimal revascularization strategies must remain individualized, grounded in robust clinical evidence, and supported by ongoing research.