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Updated: May 14, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Physiologic approach for coronary intervention
1Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 94305, USA. wfearon@stanford.edu
Insights
Fractional flow reserve (FFR) accurately identifies coronary artery disease causing symptoms and future cardiac events. FFR-guided treatment improves outcomes for significant lesions, while non-significant ones can be managed medically.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Assessing coronary artery disease invasively requires identifying symptom-causing and prognostically significant lesions.
- Myocardial ischemia is the key indicator of lesion significance for symptoms and future cardiac events.
Purpose of the Study:
- To highlight the role of Fractional Flow Reserve (FFR) as the reference standard in identifying ischemia-producing coronary artery lesions.
- To emphasize the benefits of FFR-guided percutaneous coronary intervention and medical management.
Main Methods:
- Utilizing a coronary pressure wire to measure FFR in the catheterization laboratory.
- Assessing lesion-specific ischemia with high spatial resolution.
Main Results:
- FFR is the gold standard for identifying ischemia-producing lesions, offering vessel-specific and lesion-specific accuracy.
- FFR-guided percutaneous coronary intervention improves patient outcomes and resource utilization.
- Non-hemodynamically significant lesions managed medically show a low rate of subsequent cardiac events.
Conclusions:
- FFR measurement is crucial for accurate diagnosis and guiding treatment in coronary artery disease.
- FFR-guided revascularization improves outcomes compared to non-guided approaches.
- Medical management is a safe and effective strategy for non-significant coronary lesions.
Abstract:
When invasively assessing coronary artery disease, the primary goal should be to determine whether the disease is causing a patient's symptoms and whether it is likely to cause future cardiac events. The presence of myocardial ischemia is our best gauge of whether a lesion is responsible for symptoms and likely to result in a future cardiac event. In the catheterization laboratory, fractional flow reserve (FFR) measured with a coronary pressure wire is the reference standard for identifying ischemia-producing lesions. Its spatial resolution is unsurpassed with it not only being vessel-specific, but also lesion-specific. There is now a wealth of data supporting the accuracy of measuring FFR to identify ischemia-producing lesions. FFR-guided percutaneous coronary intervention of these lesions results in improved outcomes and saves resources. Non-hemodynamically significant lesions can be safely managed medically with a low rate of subsequent cardiac events.
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