Stepwise Assessment of Computational Coronary Physiology and Plaque Vulnerability: Impact on Coronary Revascularization Decision Making | JACC: Asia

0:00Hi, my name is Enrico Fabriz. I am an international cardiologist at the University Hospital in Trieste, Italy. Today is my pleasure to describe to you a very interesting study in Jack Haysia by Dr. Lig and colleagues across multiple centers in China and entitled Stepwise Assessment of Computational and Coronary Physiology and Plakville Narability, Impact on Coronary Rascalization Decision Making. The goal of the study was to understand how had the new layers of information, physiological, biomechanical, and imaging-based, influence the vasculization decisions for intermediate coronary lesions. A total of 87 interventional cardiologists from 30 centers evaluated 25 coronary lesions producing 1,975 individual decision sets.

1:01The investigators presented case information in a stepwise manner. First, physicians reviewed angiography alone. Then, additional data were provided step-by-step. First, MuFR, a physiological index obtained from angiography. Second, a radial wall strain, a biomechanical marker of Plakville Narability, and third, optical coronary tomography, including both qualitative morphology and the quantitative lipid-to-cap ratio metric. A deep step, decisions changed substantially. A deep, MuFR changed 21% of the sheeions with most shift moving from planet PCI to medical therapy. A deep, radial wall strain produced further changes in 60% of the sheeions

2:03with many now shifting in favor of the vasculization because of increased Plakville Narability. Finally, OCT had the largest impact changing 29% of the sheeions based on qualitative interpretation and 16% when using the quantitative lipid-to-cap ratio metric. These findings highlight two important realities. First, angiography alone, frequently misrepresent the physiological severity and potentially the biological risk of coronary lesions. Second, integrating multi-parametric data enables more granular and personalized the sheeion making. What does a mean for clinical practice? The study suggests that combining physiology, biomechanics and highly-solution imaging can help us to decide which patient should receive PCI and which can be treated with optimized medical therapy

3:07including more intensive lipid lowering strategies. Looking ahead, the field will need prospective studies with clinical outcomes to confirm that these the sheeion changes translate into better outcomes as well as strategies to integrate this tool into everyday workflow. Hopefully, these will announce personalized management strategies and support the transition to precision medicine in coronary artery disease.