{
  "abstract": "Coronary computed tomography angiography (CTA), initially adopted as a rule-out modality for obstructive coronary artery disease, has undergone a marked evolution. Increasingly, CTA is used to guide downstream management through integrated anatomical assessment, plaque characterisation and non-invasive physiology via CT-derived fractional flow reserve (FFRCT). FFRCT is now a validated method for assessing lesion-specific ischaemia non-invasively and is incorporated into several contemporary diagnostic pathways.1 2 The ADVANCE-DK registry3 demonstrated that patients with normal FFR have a favourable long-term prognosis, supporting safe deferral of invasive evaluation and revascularisation. Against this background, in patients with chronic coronary syndromes (CCS), percutaneous coronary intervention (PCI) is associated with improved quality of life4 and a reduction in urgent revascularisation when guided by FFR.5 The prognostic benefit of complete revascularisation in stable lesions has been most clearly demonstrated in acute coronary syndrome patients with multivessel disease. Randomised controlled trials have consistently shown that complete revascularisation of non-culprit, physiologically significant lesions improves outcomes. The COMPLETE trial demonstrated a reduction in cardiovascular death or myocardial infarction with complete revascularisation in multivessel disease6. Similarly, DANAMI-3–PRIMULTI reported improved outcomes when residual lesions were treated on the basis of FFR rather than angiographic appearance alone.7 Taken together, these studies indicate that physiologically guided complete revascularisation is associated with better clinical outcomes.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, Aalborg University Hospital Department of Cardiology, Aalborg, Denmark"
      ],
      "name": "Ashkan Eftekhari"
    }
  ],
  "title": "Extending coronary physiology beyond the cath lab",
  "uid": "03cba00b-0e29-5fec-a154-3abd9647c512"
}