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Coronary artery pressure measurement is fundamental in treating angiographically intermediate lesions. Inappropriate percutaneous coronary intervention (PCI) in non-flow limiting coronary stenosis can lead lead to complications of stent thrombosis and a potential increase in mortality. It is, thus, important to understand physiological interpretation to guide coronary revascularization. This activity reviews coronary arterial pressure measurement tools and highlights the role of the interventional cardiology team in improving the clinical outcomes of patients undergoing PCI. Objectives: Identify the indications of physiological assessment using FFR and iFR. Describe the technical aspects of performing a coronary pressure measurement with iFR. Outline appropriate evaluation of the potential complications and clinical significance of coronary arterial pressure measurement. Describe interprofessional team strategies for improving care coordination and communication to advance coronary artery pressure measurements and improve outcomes. Access free multiple choice questions on this topic.
The diagnosis of epicardial coronary artery disease (CAD) during left heart catheterization is made through the angiographic interpretation of percent narrowing of the arterial lumen. The severe stenotic lesions typically have an appearance of at least 70 percent diameter reduction. However, there is often inter-observer variability in the assessment of intermediate lesions (40% to 70% stenosis). These lesions may have functional impairment of flow distally to cause myocardial ischemia and eventually left ventricular contractile dysfunction. The physiologic assessment of such lesions is paramount in the cardiac catheterization lab.
The complications are similar to any PCI and include vessel dissection, perforation, embolism, and coronary spasm. Other complications of a diagnostic catheterization include vascular complications, contrast induced nephropathy, stroke, myocardial infarction, arrhythmias and death.
After identification of an intermediate severity lesion during angiography, coronary artery pressure measurement with FFR or iFR should be done to determine the use of further intervention, which has shown to improve clinical outcomes.
Coronary artery pressure measurement is an invasive procedure performed in the cath lab with an interprofessional team approach. While an intervnetional cardiologist perform the procedure with a tech or fellow, the nursing staff assists with continuous monitoring of patients clinical status, delivering medications and handing all equipment.
The interprofessional team of nurses, radiation technologists, fellow, and the interventional cardiologist closely monitors vital signs, technical aspects, sterility of the procedure along with the safety of the staff and patient from radiation exposure.