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(Circulation. 2001;103:2873.)
© 2001 American Heart Association, Inc.

Editorial

Looks Aren’t Everything

FFR B4 U PTCA

Robert F. Wilson, MD

From the Cardiovascular Diseases Section, Department of Medicine, University of Minnesota, Minneapolis, Minn.

Correspondence to Robert F. Wilson, MD, MMC 508, 420 Delaware St SE, Minneapolis, MN 55455. E-mail wilso008@tc.umn.edu

Key Words: Editorials • stenosis • coronary disease • physiology

The selection of patients for coronary revascularization procedures is one of the most important and widely studied decisions in cardiovascular medicine. The article by Bech et al¹ in the current issue of Circulation is a landmark study that should guide clinicians in more precisely selecting which stenotic lesions should be dilated and which are better left alone.

Coronary angiography, once a complicated procedure, was developed to determine whether coronary arteries were narrowed enough to restrict blood flow to the myocardium. Now, coronary angiography is easy, but interpretation of the findings has become increasingly difficult as our knowledge of atherosclerosis has broadened. The problems have centered around 2 questions: how much stenosis is needed to cause a clinically significant reduction in blood flow, and does the severity of stenosis relate to its propensity to cause infarction?

The translation of angiographically determined arterial stenosis to physiologically relevant reductions in coronary blood flow dates to the seminal work of Gould et al in 1974.² He demonstrated in animals that resting coronary blood flow remained normal until 85% to 90% of the coronary cross-sectional area was occluded. This is because blood flow in healthy coronary arteries is regulated by the microcirculation, which has substantial constrictive tone at rest. With progressive stenosis in the upstream coronary, the microcirculation dilates. This fall in microvascular resistance compensates for the stenotic resistance in the large coronary, preserving overall coronary resistance and blood flow at rest. This is one of the reasons that many patients with stenotic lesions have . . . [Full Text of this Article]

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