Fractional flow reserve in acute coronary syndromes: A review

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Fractional flow reserve (FFR) is crucial for guiding treatment in coronary artery disease (CAD).
• Current evidence primarily supports FFR in stable ischemic heart disease, with limited investigation in acute coronary syndromes (ACS).
• Adenosine-induced hyperemia for FFR may be contraindicated in acute myocardial infarction (AMI).

Purpose of the Study:

• To critically review the existing data on FFR utilization across the spectrum of ACS.
• To evaluate FFR's role in analyzing both culprit and non-culprit lesions in ACS.
• To explore alternative physiological assessment methods for ACS when vasodilation is not feasible.

Main Methods:

• Comprehensive literature review of studies assessing FFR in ACS.
• Analysis of FFR application in both culprit and non-culprit coronary arteries.
• Review of instantaneous wave-free ratio (iFR) as a vasodilator-independent alternative.

Main Results:

• FFR data in ACS is less robust compared to stable ischemic heart disease.
• Challenges exist in using adenosine for FFR assessment during AMI due to patient comorbidities.
• Instantaneous wave-free ratio (iFR) emerges as a promising vasodilator-independent method for lesion severity assessment in ACS.

Conclusions:

• Further research is needed to establish the role of FFR in managing ACS.
• iFR offers a viable alternative for guiding revascularization in ACS, particularly when vasodilation is a concern.
• Physiological assessment is essential for optimizing treatment strategies in ACS patients.