Interventional Cardiology

There are currently two guideline-recommended diagnostic criteria in use to define a periprocedural myocardial infarction (PPMI) following coronary artery bypass grafting (CABG): the 4th Universal Definition of Myocardial Infarction (UDMI) and the Society of Cardiovascular Angiography and Interventions (SCAI).

European and American experts recommend physiology-guided myocardial revascularisation.1,2,3 Nevertheless, physiology-guided revascularisation does not exceed 10% in the best scenario, worldwide.

Treating chronic total occlusions (CTO) by the antegrade approach requires appropriate devices and skill in resource-limited settings. Good guide-catheter support is crucial.1,2 Patients with diabetes and narrower radial arteries are prone to spasm with larger guiding catheters, and may benefit from a slender approach to percutaneous coronary intervention (PCI).

Today, coronary flow reserve (CFR) is used to evaluate the microcirculation, but not the haemodynamic significance, of coronary stenosis. Fractional flow reserve (FFR) is the gold standard for this purpose, with a cut-off value of 0.8 for intervention. Its simplicity, however, limits its predictive value.