Fractional flow reserve application in everyday practice: adherence to clinical recommendations

Fractional flow reserve (FFR) is considered the gold standard for invasive assessment of functional, significant coronary stenosis. Nevertheless, its application and outcome in daily practice is rarely reported. We investigated whether decisions in clinical practice adhered to FFR-generated recommendations and whether FFR influenced cardiovascular outcomes. This retrospective, observational, cohort study included 189 patients that underwent FFR measurements during coronary angiography at our institution The median follow up was 27 months (range, 7-112 months). Clinical outcomes (up to 2 years) included all-cause mortality, cardiac-mortality, and major adverse cardiac events (MACE) which comprised cardiac mortality, non-fatal MI, target vessel revascularization, and coronary artery bypass graft (CABG). Patients most frequently presented with unstable angina (74.6%). Only 55 patients (29.1%) exhibited significant functional stenosis (FFR ≤0.8). Nevertheless, 68 patients (36%) underwent immediate coronary interventions; 64% were deferred from revascularization procedures and managed conservatively with optimal medical treatment. Thirty-five patients (18.5%) were treated in discordance with FFR results, but the overall MACE rate was similar to that of patients treated in concordance with FFR results (8.3% vs. 8.6%, P=0.41). In conclusion, in our everyday practice, the operator's decision was in discordance to the FFR measurements and indications in nearly 20% of cases. In these selected cases, the operator's subjective judgment may continue to play an important role.