Key result
Invasive physiologic testing optimizes PCI outcomes, yet real-world adoption remains critically low at under ~20%.
Why the study?
Although landmark trials and Class I guidelines establish physiologic testing as central to revascularization, real-world adoption remains critically low at less than 1 in 5 of eligible cases.
Provides a practical step-by-step framework to overcome technical barriers and increase real-world adoption of guideline-recommended coronary physiologic testing (currently used in <1 in 5 eligible cases) to optimize PCI outcomes.
Answers are grounded in this paper and cite their sources.
May support broader adoption of guideline-recommended physiologic testing during PCI; leaves open effectiveness of implementation strategies in routine practice.
Coronary angiography remains an imperfect tool for assessing functional ischemia in intermediate lesions. This review highlights evidence-based diagnostic and therapeutic approaches in coronary physiology to bridge the gap between guideline recommendations and real-world clinical practice. Although landmark trials and Class I guidelines establish physiologic testing as central to revascularization, real-world adoption remains critically low at less than 1 in 5 of eligible cases. Recent research emphasizes using both hyperemic (FFR) and non-hyperemic pressure ratios (iFR, RFR, DFR, dPR) grounded in pressure-flow dynamics to improve decision-making. Invasive physiology optimizes percutaneous coronary intervention (PCI) accuracy and patient outcomes. Implementing a systematic step-by-step approach empowers clinicians to overcome technical barriers, driving higher adoption and expanding precise, physiology-guided revascularization into routine practice. In this review, we provide a practical guide to performing, interpreting, and applying physiologic testing in contemporary practice.
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Bae et al. (2026) conducted a review in Coronary artery disease with intermediate lesions. Invasive coronary physiologic testing (hyperemic FFR and non-hyperemic pressure ratios: iFR, RFR, DFR, dPR) vs. Coronary angiography alone was evaluated. Invasive physiologic testing optimizes PCI accuracy and outcomes, yet real-world adoption remains critically low at <1 in 5 of eligible cases despite Class I guideline support.
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