It is speculated that, 5 years from now, patients with SIHD will be managed medically, based on OMT, symptoms and appropriateness criteria for diagnosis and intervention. Evaluation for ischemia will be the standard of care and ischemia imaging data from before, during and late after intervention for SIHD will be linked into a single continuum for the documentation, ongoing assessment and appropriateness of management of SIHD.
When clinical symptoms drive evaluation for intervention, the functional and anatomic data obtained from the catheterization laboratory and imaging studies are used to model outcomes from selected interventions, including stenting, bypass grafting, or both. Measurements obtained at the time of intervention directly confirm the efficacy of the intervention, also validating the therapeutic decision to intervene in that manner. These data are combined into the continuum of information regarding the patient's disease process and enable the management and therapy to be specifically patient-centric.
In this vision, the anatomy and functionality combine to affect the underlying physiology of blood flow and perfusion at a TVECA level. Furthermore, this underlying physiology of revascularization, regardless of technique, may become the common lexicon for diagnosis, decision-making, intervention and outcomes in patients with SIHD.
Future Cardiol. 2014;10(1):63-79. © 2014 Future Medicine Ltd.