Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Coronary artery disease

Percent stenosis in CAD—a flaw in current practice

The optimum strategy to treat patients with coronary artery disease (CAD) has been under debate. New data show that revascularization guided by fractional flow measurements leads to better outcomes than revascularization guided by arteriography. We call for a paradigm shift in CAD care, with coronary flow measurements by PET as key to diagnosis and clinical decision-making.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: PET of myocardial perfusion during stress.

References

  1. Pijls, N. H. et al. for the FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J. Am. Coll. Cardiol. 56, 177–184 (2010).

    Article  PubMed  Google Scholar 

  2. Tonino, P. A. et al. for the FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N. Engl. J. Med. 360, 213–224 (2009).

    Article  CAS  PubMed  Google Scholar 

  3. Boden, W. E. et al. for the COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N. Engl. J. Med. 356, 1503–1516 (2007).

    Article  CAS  PubMed  Google Scholar 

  4. Gould, K. L. Does coronary flow trump coronary anatomy? JACC Cardiovasc. Imaging 2, 1009–1023 (2009).

    Article  PubMed  Google Scholar 

  5. White, C. W. et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N. Engl. J. Med. 310, 819–824 (1984).

    Article  CAS  PubMed  Google Scholar 

  6. Topol, E. J. & Nissen, S. E. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92, 2333–2342 (1995).

    Article  CAS  PubMed  Google Scholar 

  7. Meijboom, W. B. et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J. Am. Coll. Cardiol. 52, 636–643 (2008).

    Article  PubMed  Google Scholar 

  8. Tonino, P. A. et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study: fractional flow reserve versus angiography in multivessel evaluation. J. Am. Coll. Cardiol. 55, 2816–2821 (2010).

    Article  PubMed  Google Scholar 

  9. Lin, G. A., Dudley, R. A. & Redberg, R. F. Cardiologists' use of percutaneous coronary interventions for stable coronary artery disease. Arch. Intern. Med. 167, 1604–1609 (2007).

    Article  PubMed  Google Scholar 

  10. Sdringola, S. et al. Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease. J. Am. Coll. Cardiol. 41, 263–272 (2003).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K. Lance Gould.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gould, K., Johnson, N. Percent stenosis in CAD—a flaw in current practice. Nat Rev Cardiol 7, 482–484 (2010). https://doi.org/10.1038/nrcardio.2010.119

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrcardio.2010.119

This article is cited by

  • Cardiac hybrid imaging

    • Oliver Gaemperli
    • Philipp A. Kaufmann
    • Hatem Alkadhi

    European Journal of Nuclear Medicine and Molecular Imaging (2014)

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing