Top Things to Know: Evidence-Based Practices in the Cardiac Catheterization Laboratory: Invasive Epicardial Coronary Physiologic Assessment
Published: November 20, 2025
Prepared by Anne Leonard, MPH, RN, National Senior Director Science and Medicine
- Guidelines on coronary revascularization recommend invasive coronary physiologic assessment to aid decision making in patients with intermediate coronary lesions (40% to 69% stenosis on visual assessment).
- This scientific statement discussed assessments done in clinical practices versus those based on evidence in several key areas.
- The paper examines the accuracy of non-hyperemic pressure ratio or NHPR when compared with fractional flow reserve (FFR).
- For FFR and NHPR, continuous versus categorical thresholds are compared in this paper. Best clinical decisions should be coupled to the FFR or NHPR value (as a continuous measure) and considered in the clinical context of the patient’s presentation.
- Intracoronary versus intravenous route and dosing for adenosine for hyperemia is discussed in this statement. For FFR measurement, the administration of adenosine via the intravenous (IV) route is the preferred route. The advantages of IV administration are outlined in this statement.
- Contrast FFR has advantages compared to NHPR with greater accuracy in assessing coronary artery pressure differences across coronary artery stenosis during hyperemia.
- Other clinical practices discussed in this statement include: disengagement of the guide catheter, the ideal starting position of the pressure sensor within the vessel when performing functional assessment, assessing for pressure signal drift, FFR or NHPR in select lesion subsets (acute coronary syndromes, severe aortic stenosis, predict non-viable myocardium, donor vessel supplying collaterals to a segment with a chronic total occlusion, left main stenosis, tandem lesions, ostial lesions, FFR or NHPR in saphenous vein graft (SVG grafts), and myocardial bridge.
- Post PCI Physiology Measurement when to perform it and what it means.
- Suggested practices for invasive coronary physiologic assessments are outlined in this paper during the pre-procedure, intra procedure and post procedure periods.
- Accurate assessment of invasive coronary physiology is critical for best practices for PCI.
Citation
Bangalore S, Fearon WF, Fugar S, Dangas GD, Iqbal S, Johnson NP, Power D, Tamis-Holland J, Kern MJ; on behalf of the American Heart Association Interventional Care Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing. Evidence-based practices in the cardiac catheterization laboratory: invasive epicardial coronary physiologic assessment: a scientific statement from the American Heart Association. Circulation. Published online November 20, 2025. doi: 10.1161/CIR.0000000000001389