Clinical Application of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention for Stable Coronary Artery Disease
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Published on: August 25, 2023
Valay Parikh1, Kanishk Agnihotri2, Sabeeda Kadavath3
1Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA. valayparikh@gmail.com.
Insights
Fractional flow reserve (FFR) helps determine if coronary artery blockages truly reduce blood flow in stable ischemic heart disease (SIHD). This guides decisions on revascularization, preventing unnecessary procedures for functionally insignificant lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Physiology
Background:
- Revascularization is indicated for stable ischemic heart disease (SIHD) patients with angina and significant coronary stenosis.
- Coronary angiography alone may inaccurately assess the hemodynamic significance of intermediate-grade stenoses.
- Intervention on functionally insignificant lesions can lead to adverse outcomes.
Purpose of the Study:
- To review the principle and utility of Fractional Flow Reserve (FFR) in assessing coronary lesion significance.
- To discuss the evidence and rationale supporting FFR use in clinical decision-making.
- To compare FFR with other available diagnostic modalities.
Main Methods:
- Review of existing literature on Fractional Flow Reserve (FFR).
- Discussion of the physiological basis for FFR measurement.
- Analysis of clinical trial data and guidelines supporting FFR implementation.
Main Results:
- FFR accurately identifies functionally significant coronary artery stenoses.
- Guidewire-based pressure measurements provide a reliable assessment of lesion-induced ischemia.
- FFR integration into decision-making improves patient selection for revascularization.
Conclusions:
- FFR is a crucial tool for assessing the hemodynamic significance of coronary lesions in SIHD.
- Utilizing FFR aids in judicious decision-making in the cardiac catheterization laboratory.
- FFR promotes appropriate use of percutaneous coronary intervention (PCI) and avoids interventions on non-significant lesions.
Abstract:
Revascularization in stable ischemic heart disease (SIHD) is indicated in patients on optimal medical therapy with angina and/or demonstrable ischemia and a significant stenosis in one or more epicardial coronary arteries. Angiography alone, however, cannot accurately determine the hemodynamic significance of coronary lesions, particularly those of intermediate stenosis severity. A lesion may appear significant on coronary angiogram but may not have functional significance. Percutaneous coronary intervention (PCI) of functionally insignificant coronary artery lesions may have serious consequences; therefore, judicious decision-making in the cardiac catheterization laboratory is indicated. For this reason, it is becoming increasingly important to show that a stenosis is capable to induce myocardial ischemia prior to intervention. Fractional flow reserve (FFR) has emerged as a useful tool for this purpose. In this review, we will briefly discuss the principle of FFR, current evidence and rationale supporting its use, and comparison with other modalities.
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