Drs. Allen Jeremias and Hayder Hashim emphasize that coronary physiology—not angiography alone—should guide what to treat and how to plan PCI. They advocate starting with physiology to identify ischemia and combine this insight with intravascular imaging to identify plaque modification and precisely plan stent length and placement. Drawing on data from studies such as DEFINE PCI and DEFINE GPS, they highlight that residual ischemia after PCI is common and often explains persistent angina, underscoring the value of both pre- and post-PCI physiological assessment.
In this expert discussion, Drs. Allen Jeremias and Hayder Hashim explore why coronary physiology should be the foundation of PCI decision-making. Rather than relying on subjective angiographic interpretation, they highlight the value of physiological assessment to identify ischemia, understand disease patterns, and plan treatment with confidence.
By combining physiology with intravascular imaging, physicians can precisely determine what to treat, how much to treat, and where to land—reducing guesswork and unnecessary stenting. Advanced tools such as SyncVision help quantify lesion contribution and predict post-PCI outcomes, supporting more informed procedural planning.
Supported by evidence from DEFINE clinical trials, this integrated approach demonstrates how physiology-guided, imaging-supported PCI can help minimize residual ischemia, reduce persistent angina, and improve patient outcomes—pointing toward the future standard of care in the cath lab.