Commentary

A New View: Invasive Assessment of Coronary Artery Lesions

In this issue of Cardiology Today’s Intervention, we are lucky to have a deep dive on invasive assessment of coronary artery lesions using fractional flow reserve and instantaneous wave-free ratio. The amount of data regarding use of FFR has grown tremendously over the past several years, and it has now become one of the most well-researched tools in the interventional toolkit. More recently, data supporting the similar benefits of iFR in evaluating ambiguous lesions have also emerged.

However, the much bigger issue, as opposed to whether FFR or iFR is better, is why we are not doing more of this type of invasive interrogation of intermediate lesions prior to deciding upon stenting or medical therapy, or even bypass surgery. There is enormous pressure in the current health care system to contain costs, and it does appear that use of these technologies could limit stenting to those patients who are most likely to benefit among patients with stable CAD that is symptomatic. As the data for these technologies have accumulated, the guidelines as well should reflect greater enthusiasm for using these modalities. Uptake still remains below what is likely optimal levels, though use will undoubtedly climb as evidence continues to come in, as guidelines and maybe even third-party payers endorse the use of these techniques, and as it becomes easier to do these procedures because of technical advances. Please look inside this issue for detailed discussions on how to integrate these technologies into your practice.

This is always a particularly exciting time of year and a timely issue of Cardiology Today’s Intervention, as it coincides with the Transcatheter Cardiovascular Therapeutics conference. Many of you may be picking up this issue while attending TCT, and hopefully it conveys to you some of the excitement that we try to bring in each issue, even when you are not attending an interventional meeting. For those of you who cannot attend TCT, we will make sure in our next issue to provide a recap of all the important studies being presented at this year’s meeting.

Deepak L. Bhatt, MD, MPH
Chief Medical Editor
Cardiology Today’s Intervention

In this issue of Cardiology Today’s Intervention, we are lucky to have a deep dive on invasive assessment of coronary artery lesions using fractional flow reserve and instantaneous wave-free ratio. The amount of data regarding use of FFR has grown tremendously over the past several years, and it has now become one of the most well-researched tools in the interventional toolkit. More recently, data supporting the similar benefits of iFR in evaluating ambiguous lesions have also emerged.

However, the much bigger issue, as opposed to whether FFR or iFR is better, is why we are not doing more of this type of invasive interrogation of intermediate lesions prior to deciding upon stenting or medical therapy, or even bypass surgery. There is enormous pressure in the current health care system to contain costs, and it does appear that use of these technologies could limit stenting to those patients who are most likely to benefit among patients with stable CAD that is symptomatic. As the data for these technologies have accumulated, the guidelines as well should reflect greater enthusiasm for using these modalities. Uptake still remains below what is likely optimal levels, though use will undoubtedly climb as evidence continues to come in, as guidelines and maybe even third-party payers endorse the use of these techniques, and as it becomes easier to do these procedures because of technical advances. Please look inside this issue for detailed discussions on how to integrate these technologies into your practice.

This is always a particularly exciting time of year and a timely issue of Cardiology Today’s Intervention, as it coincides with the Transcatheter Cardiovascular Therapeutics conference. Many of you may be picking up this issue while attending TCT, and hopefully it conveys to you some of the excitement that we try to bring in each issue, even when you are not attending an interventional meeting. For those of you who cannot attend TCT, we will make sure in our next issue to provide a recap of all the important studies being presented at this year’s meeting.

Deepak L. Bhatt, MD, MPH
Chief Medical Editor
Cardiology Today’s Intervention