Don’t Judge Stenosis Severity Solely by Intravascular Ultrasound

In this issue of Circulation: Cardiovascular Interventions, Kang et al1 compare intravascular ultrasound (IVUS) parameters against a gold standard of fractional flow reserve (FFR) for evaluating intermediate stenoses. Their work adds another piece of evidence to a debate whose outcome is fundamentally changing interventional cardiology. As encapsulated by the title of the “FFR versus Angiography for Multivessel Evaluation” (FAME) trial,2 the debate can be summarized simply: physiology versus anatomy. Its urgency and importance cannot be more clear, given recent skepticism toward the value of percutaneous coronary intervention (PCI): its ranking as 1 of the 10 most overused procedures in a consumer report3; litigation against an interventional cardiologist for allegedly implanting inappropriate stents4; and an editorial in a prominent medical journal calling to end ad hoc PCI.5 Therefore, the work by Kang et al1 is both timely and relevant.