12.1 Manual of PCI - Coronary physiology

Coronary physiology is performed in order to: (a) assess the hemodynamic significance of native coronary lesion and determine the need for PCI; and (b) to assess whether an optimal result was achieved after PCI.

Both hyperemic (usually adenosine FFR) and non-hyperemic indices (such as iFR, dPR, RFR) can be used, with non-hyperemic indices used more commonly as they are easier to perform.

Coronary physiologic assessment is performed in 8 steps, as follows:
1. Flush + zero pressure wire
2. Insert pressure to tip of guide
3. Remove introducer, flush guide with NS, equalize pressures
4. Advance pressure wire distal to the target lesion
5. Measure resting physiologic index
6. Measure hyperemic FFR (if needed)
7. Pullback
8. Check for drift