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Updated: Apr 1, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
The Impact of Fractional Flow Reserve on Revascularization
Islam Y Elgendy1, Calvin Choi1,2, Anthony A Bavry3,4
1Department of Medicine, University of Florida, Gainesville, FL, USA.
Insights
Fractional flow reserve (FFR) was used in 23% of cardiac catheterizations. FFR assessment identified non-ischemic lesions in half of intermediate coronary lesions, significantly reducing unnecessary revascularization procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Fractional flow reserve (FFR) is guideline-recommended for assessing intermediate coronary lesions when non-invasive ischemia evidence is lacking.
- Current FFR utilization and its influence on revascularization decisions remain unclear.
Purpose of the Study:
- To investigate the prevalence of FFR usage in clinical practice.
- To analyze how FFR values impact decisions regarding revascularization of intermediate coronary lesions.
Main Methods:
- Prospective data collection from May 2012 to January 2014 at a Veterans Administration Hospital.
- FFR measurement in intermediate coronary lesions (30-70% stenosis).
- Lesion categorization: non-ischemic (FFR > 0.80), gray zone (FFR 0.75-0.80), and ischemic (FFR < 0.75).
Main Results:
- FFR was performed in 347 (23%) of 1482 cardiac catheterizations.
- Of 429 intermediate lesions, 211 were non-ischemic (95% deferred revascularization), 73 in the gray zone, and 145 ischemic.
- Revascularization decisions varied based on FFR: 95% of non-ischemic lesions were deferred, while ischemic lesions underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
Conclusions:
- FFR is utilized in approximately 23% of cardiac catheterizations at this VA hospital.
- FFR effectively identified non-ischemic intermediate coronary lesions, leading to a significant reduction in revascularization procedures.
Introduction:
Fractional flow reserve (FFR) is recommended by society guidelines for assessment of the hemodynamic significance of intermediate coronary lesions when non-invasive evidence of myocardial ischemia is unavailable. However, the prevalence of FFR usage in current practice and how FFR values impact revascularization decisions are not well known.
Methods:
At a single-center Veterans Administration Hospital, all subjects referred for coronary angiography for any indication from the period from May 2012 until January 2014 were prospectively entered into a database. FFR was measured in all intermediate coronary lesions (30-70% stenosis). Based on the FFR results, the lesions were categorized into 3 different groups: FFR > 0.80 (non-ischemic), FFR 0.75-0.80 (gray zone), and FFR < 0.75 (ischemic).
Results:
A total of 1482 cardiac catheterizations were performed during the study period. FFR was performed in 347 (23%) of these procedures. The total numbers of intermediate coronary lesions evaluated with FFR were 429. The mean FFR value was 0.79 (median = 0.80; interquartile range 0.64-0.96). Among 211 non-ischemic lesions, revascularization was deferred in 201 (95%). In the gray-zone group (73 lesions), 35 (48%) lesions were treated with percutaneous coronary intervention (PCI), 11 (15%) lesions were referred for coronary artery bypass grafting surgery (CABG), and 27 (37%) lesions were treated medically. In the ischemic group (145 lesions), 82 (57%) lesions were treated with PCI, 41 (28%) lesions were referred for CABG, and 22 (15%) lesions were treated medically.
Conclusion:
At a Veterans Administration Hospital, FFR was performed in approximately one out of four total catheterizations. FFR documented lack of ischemia in about half of the intermediate coronary lesions, and thus reduced the need for many revascularization procedures.
