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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Should we be using fractional flow reserve more routinely to select stable coronary patients for percutaneous
Seung-Jung Park1, Jung-Min Ahn
1Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. sjpark@ amc.seoul.kr
Insights
Fractional flow reserve (FFR) measurement guides treatment decisions for stable coronary artery disease (CAD). FFR-guided interventions improve outcomes and reduce costs, supporting routine use in patient selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Decision Making
Background:
- The clinical benefit of revascularization in stable coronary artery disease (CAD) remains a subject of debate.
- Fractional flow reserve (FFR) is the established gold standard for assessing the functional significance of intermediate coronary artery stenosis.
- Consensus exists that revascularization of ischemic-producing lesions can enhance clinical outcomes.
Purpose of the Study:
- To evaluate the clinical utility and benefits of employing fractional flow reserve (FFR) measurements in patients diagnosed with stable coronary artery disease (CAD).
- To determine the impact of FFR-guided treatment strategies on patient outcomes and healthcare economics.
Main Methods:
- Review of clinical evidence and guideline recommendations regarding the use of FFR in stable CAD.
- Analysis of data from major trials, including FAME II, assessing FFR-guided percutaneous coronary intervention (PCI).
- Evaluation of FFR thresholds for deferring revascularization and guiding treatment decisions.
Main Results:
- Intermediate coronary stenosis with an FFR > 0.80 can be safely deferred, showing low annual event rates (<1%).
- Revascularization for lesions with FFR ≤ 0.80, guided by FFR, demonstrated significant clinical benefits over optimal medical treatment.
- FFR-guided PCI in multivessel CAD improved clinical outcomes and reduced overall medical costs compared to standard approaches.
Conclusions:
- FFR measurement is a crucial invasive functional assessment tool for selecting appropriate patients and lesions for revascularization in stable CAD.
- Routine utilization of FFR can prevent unnecessary procedures, decrease healthcare expenditures, and ultimately improve patient clinical outcomes.
- Current guidelines support the use of FFR (Level of Evidence A) when the ischemic potential of target lesions is uncertain.
Purpose Of Review:
To address the clinical benefit of fractional flow reserve (FFR) measurement in stable coronary artery disease (CAD) patients.
Recent Findings:
The efficacy of revascularization in patients with stable CAD has been debatable. However, there has been consensus that revascularization for ischemic-producing lesions may improve clinical outcomes. FFR is considered nowadays as the gold standard for the invasive assessment of ischemic potential of intermediate coronary artery stenosis. Intermediate stenosis with FFR of greater than 0.80 has been demonstrated to be safely deferred with annual event rate less than 1%. Recently, preliminary data of FAME II trial presented that revascularization for stenosis with FFR of 0.80 or less has clinical benefits over optimal medical treatment with respect to the reduction of unplanned hospitalization and urgent revascularization in stable CAD patients. A large randomized controlled trial demonstrated that FFR-guided percutaneous coronary intervention (PCI) improved clinical outcomes while reducing the medical costs in multivessel CAD. Therefore, current guidelines recommend the consideration of FFR measurements as level of evidence 'A' when the ischemic potential for specific target lesions is questionable.
Summary:
Much clinical evidence indicates that use of this dedicated invasive functional method may help in selecting appropriate patients and lesions for treatment, avoiding unnecessary procedures, reducing medical costs, and improving each patient's clinical outcomes. Therefore, we should use FFR more routinely to select stable coronary patients for PCI.
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