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A physiological approach to refine appropriateness of revascularization, clinical decision making and prognosis in patients with multi vessel coronary artery disease.

Patients with multivessel coronary artery disease (CAD) constitute a high-risk cohort and coronary artery bypass graft surgery (CABG) has been the established mainstay of treatment. There, exists, however, significant heterogeneity in the multivessel disease (MVD) population (1). With improved durability of newer generation drug eluting stents, PCI is being increasingly performed in patients with more complex MVD, especially with the recent advances in percutaneous chronic total occlusion (CTO) recanalization. Similarly, from a patient outcome standpoint, optimal medical therapy has been shown to be as effective as revascularization in patients with stable ischemic heart disease (2,3).