The presentation addresses different questions and related data for the analysis of PCI:

• Why do we perform PCI to treat angina?
  • PCI improves angina by treating flow limiting stenosis
• Is PCI better than antianginal medication?
  • ISCHEMIA trial (impact of an invasive strategy on angina pectoris)
• How good is PCI in relieving angina in available PCI studies?
  • ABSORB IV trial (angina through 1-year follow up)
  • MR-INFORM trial
  • Post-PCI angina and procedural developments
• Is PCI superior to CABG in relieving angina?
  • SYNTAX study about angina frequency (SAQ) with PCI or CABG, also at 5 year FU
• What may cause post-PCI angina?
  • Post-PCI ischemia may an obstructive or non -obstructive cause
  • Residual SS/functional residual score on long-term outcomes
  • DEFINE PCI: blinded analysis of post-PCI results and 1-year clinical outcomes
  • HAWAKEYE trial: relevance of residual stenoses after PCI
  • TARGER FFR trial: post PCI FFR values and optimization strategy
  • PIOS (Physiology-guided Incremental Optimization Strategy)
• May post-PCI angina have a non-obstructive origin?
  • Pre-existing microvascular dysfunction and PCI results
  • Vasomotor disorders after stent implantation

Key messages include:

• PCI is a suboptimal treatment for angina in stable patients
• Potentially, the two more relevant causes of post-PCI angina are:
  • Residual obstructive disease and
  • Non-obstructive causes of myocardial ischemia
• Future research should clarify the best approach to manage these causes:
  • Simulation/prediction of functional PCI results to plan intervention
  • Assessment to final functional results of PCI followed by optimization strategies
  • Pre-PCI assessment of obstructive and non-obstructive causes of ischemia