ArticleJACC. Asia2026
Stepwise Assessment of Computational Coronary Physiology and Plaque Vulnerability: Impact on Coronary Revascularization Decision Making.
Article in JACC. Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Radial Wall Strain and the Stepwise Integration of Physiology and Vulnerability in Revascularization Decision Making.JACC. Asia · 2026Article
- Reply: Radial Wall Strain and the Stepwise Integration of Physiology and Vulnerability in Revascularization Decision Making.JACC. Asia · 2026Article
- Right Tool for Right Lesion: Moving Toward Lesion-Specific Imaging-Integrated Coronary Physiology.JACC. Asia · 2026Article
- Moving Beyond Angiography: Integrating Physiology and Plaque Vulnerability, a Step Forward in Precision Medicine.JACC. Asia · 2026Article
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Authors and funding
11 authors.
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Abstract
backgroundIncremental information on coronary physiology and plaque vulnerability may improve risk stratification beyond anatomy. Murray law-based quantitative flow ratio (μFR) and radial wall strain (RWS) are angiography-derived indices for assessing coronary physiology and plaque vulnerability, but their impact on revascularization decisions remains unclear.
objectivesThe authors aimed to evaluate the impact of incremental availability of μFR and RWS on revascularization decisions.
methodsA web-based survey was conducted, comprising 25 angiographically intermediate lesions. Data from μFR, RWS, and optical coherence tomography (OCT) were stepwisely available to participating cardiologists to make revascularization decisions (medical therapy alone or revascularization) for each lesion: Decision I was made based on angiography and clinical data, Decision II was made after μFR was disclosed, Decision III followed after RWS disclosure, and Decision IV followed after OCT disclosure.
resultsA total of 87 interventional cardiologists from 30 Chinese clinical centers provided 1,975 lesion-based decision sets. Following stepwise data disclosure, revascularization decisions remained unchanged in 1,013 (51.3%) decision sets. From Decision I to Decision II, 416 (21.1%) treatment recommendations changed, with 322 shifting from revascularization to medical therapy. From Decision II to Decision III, 315 (15.9%) recommendations changed, with 223 from medical therapy to revascularization. From Decision III to Decision IV, 564 (28.6%) recommendations changed, with 526 from medical therapy to revascularization. If decisions were strictly based on OCT-derived lipid-to-cap ratio, a validated quantification of plaque vulnerability, only 317 (16.1%) decisions would change from Decision III to Decision IV.
conclusionsRevascularization decisions for intermediate lesions changed significantly with sequential diagnostic data. Adding μFR to angiography decreased revascularization rates. Adding plaque vulnerability assessment significantly increased revascularization rates.
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