: The physiological assessment of coronary lesions is influenced by the pattern and distribution of coronary artery disease (CAD), including focal lesions, serial lesions, diffuse disease, and mixed patterns. These various patterns of CAD impact the accuracy of pressure wire and angiography-derived physiology indexes, and diffuse disease in particular is an important determinant of the anticipated outcome of percutaneous coronary intervention. Therefore, identification of the physiological pattern of disease provides relevant information for the management of CAD and percutaneous coronary intervention procedural planning. At present, the classification of physiological patterns and its implications for the tailored management of a patient with CAD are poorly defined. This state-of-the-art review provides an overview of the available evidence on functional patterns of CAD with a special focus on their diagnostic and therapeutic implications. It also aims to provide clear definitions of physiological patterns of CAD based on the available evidence and expert opinion. A practical algorithm is provided to optimize the use of pressure wire and angiography-derived indexes of coronary physiology in the settings of focal, serial, and diffuse lesions, with the addition of intracoronary imaging in selected cases.
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