Is functional assessment necessary in patients with stable angina?

Strategies during elective PCI procedures in patients with stable angina and multivessel disease are in the majority of catheterisation laboratories, more often than not based, solely on the angiographic analysis on the spur of the moment. This despite the knowledge that angiographic images are often lacking the discriminating power to predict accurately the exact physiologic impact of individual lesions. Evidence is however accumulating telling us that routine stenting of non significant lesion is at best of no additional benefit for the patient. the introduction of dedicated angioplasty guidewires equipped at the tip with a miniature pressure-sensor has greatly expanded the possibilities to accurately evaluate the functional importance of any lesion during diagnostic coronary angiogram by measuring the FFR index. Ths index, based on the measurements of the trans-stenotic coronary gradient during maximal vasodilatation, is accurate, and easy to implement. Results from several important trials (e.g.,DEFER) have brought to our attention the fact that non significant coronary lesion sas documented by FFR measurements, in patients with single vessel disease can safely be left untreated. Recently, the remarkable results from the FAME trial have made a strong case for integrating functional evaluation as a routine work up especially in the presence of angiographic ambiguous lesions referred for PCI in patients with multivessel disease.