Physiology-guided management of left main coronary artery disease faces challenges due to exclusion from major trials and co-existing downstream disease, though novel tools may improve future care.
Does physiological assessment improve the management of left main coronary artery disease compared to visual estimation?
This review highlights the challenges and potential solutions for using physiological assessment tools like FFR in the management of left main coronary artery disease.
The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as fractional flow reserve (FFR), have been shown to yield better outcomes; however, to date, major trials examining the use of such physiological indices have excluded LMCA disease. Furthermore, LMCA disease commonly co-exists with downstream disease, which complicates the interpretation of coronary physiological data. This review summarises existing evidence for physio-logy-guided management of LMCA disease. It will also explore the difficulties posed when functionally assessing LMCA lesions and outline potential solutions. Finally, we aim to provide insight into how novel physiological tools may improve the management of LMCA disease in the future.
Modi et al. (Fri,) conducted a review in Left main coronary artery (LMCA) disease. Physiology-guided management (e.g., fractional flow reserve) vs. Visual estimation on angiography was evaluated. Physiology-guided management of left main coronary artery disease faces challenges due to exclusion from major trials and co-existing downstream disease, though novel tools may improve future care.