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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Myocardial fractional flow reserve. Its role in guiding PCI in stable coronary artery disease
1Medizinische Klinik II-Kardiologie und Angiologie, BG Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, Bochum,Germany. michael.lindstaedt@rub.de
Insights
Percutaneous coronary intervention (PCI) decisions for coronary artery disease should use objective ischemia evidence. Fractional flow reserve (FFR) measurements improve patient outcomes by guiding PCI to functionally significant lesions only.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary artery revascularization guidelines emphasize objective ischemia evidence.
- Pre-procedural stress tests are often unavailable for stable coronary artery disease (CAD) patients undergoing elective percutaneous coronary intervention (PCI).
- Decisions for PCI are frequently based on angiogram review alone, despite known inaccuracies.
Purpose of the Study:
- To highlight the diagnostic superiority of fractional flow reserve (FFR) over noninvasive stress tests for assessing coronary lesion significance.
- To emphasize the importance of objective ischemia assessment in guiding PCI decisions for stable CAD.
- To underscore the clinical benefits of FFR-guided PCI strategies.
Main Methods:
- Utilizing coronary pressure wire technology to measure myocardial fractional flow reserve (FFR).
- Comparing FFR accuracy against noninvasive stress tests for detecting ischemia.
- Analyzing data from landmark FFR trials (e.g., DEFER, FAME) in patients with single and multivessel disease.
Main Results:
- FFR demonstrates superior diagnostic accuracy in identifying functionally significant coronary lesions compared to noninvasive stress testing.
- FFR-guided PCI strategies, limiting intervention to ischemic lesions, maximize clinical benefit and improve patient outcomes.
- Medical management of non-ischemic lesions, as identified by FFR, is associated with favorable outcomes.
Conclusions:
- FFR is a crucial tool for objective ischemia assessment in coronary artery disease.
- FFR-guided PCI significantly enhances patient outcomes by ensuring revascularization only for functionally significant lesions.
- Adopting FFR measurements aligns with guidelines and optimizes treatment strategies for stable CAD.
Abstract:
Revascularization of coronary artery lesions should be based on objective evidence of ischemia, as recommended by the guidelines of the European Society of Cardiology. However, even in the case of stable coronary artery disease and elective percutaneous coronary intervention (PCI), pre-procedural noninvasive stress test results are available in a minority of patients only. It is common practice for physicians to make decisions on revascularization in the catheterization laboratory after a cursory review of the angiogram, despite the well-recognized inaccuracy of such an approach. Myocardial fractional flow reserve (FFR) measured by a coronary pressure wire is a specific index of the functional significance of a coronary lesion, with superior diagnostic accuracy for the detection of ischemia than any noninvasive stress test. FFR trials on patients with single and multivessel disease, such as the DEFER and FAME studies, have demonstrated that the clinical benefit of PCI with respect to patient outcome is greatest when revascularization is limited to lesions inducing ischemia, whereas lesions not inducing ischemia should be treated medically.
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