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Fractional flow reserve (FFR) as a guide to treat coronary artery disease

Fabio Mangiacapra1, Edoardo Bressi1, Alessandro Sticchi1

  • 1a Unit of Cardiovascular Science , Campus Bio-Medico University , Rome , Italy.

Expert Review of Cardiovascular Therapy
|June 21, 2018
PubMed

Insights

Fractional flow reserve (FFR) accurately identifies ischemia-causing coronary lesions, guiding treatment decisions. FFR-guided percutaneous coronary intervention (PCI) shows superior outcomes compared to angiography-guided PCI or medical therapy alone.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Myocardial ischemia extent is critical for coronary artery disease (CAD) prognosis.
  • Fractional flow reserve (FFR) distinguishes ischemia-inducing lesions, unlike coronary angiography alone.
  • FFR enables targeted revascularization decisions in CAD patients.

Purpose of the Study:

  • To provide an overview of FFR's role in diagnosing and treating CAD.
  • To discuss the underlying coronary physiology and procedural aspects of FFR.
  • To review landmark trials, current applications, and future research directions for FFR.

Main Methods:

  • Review of FFR technique, including coronary physiology and catheterization laboratory procedures.
  • Analysis of landmark clinical trials and current applications in various coronary lesions and syndromes.
  • Comparison of FFR with non-hyperemic indices and noninvasive techniques.

Main Results:

  • FFR remains the gold standard for detecting ischemia-inducing coronary stenoses, outperforming non-hyperemic indices and noninvasive methods.
  • FFR-guided percutaneous coronary intervention (PCI) demonstrates superior outcomes compared to angiography-guided PCI.
  • FFR-guided PCI is also superior to medical therapy alone for selected CAD patients.

Conclusions:

  • FFR is unsurpassed in diagnostic performance for identifying significant coronary stenoses.
  • FFR-guided PCI offers improved clinical outcomes in CAD management.
  • Ongoing research will further define FFR's role, particularly in severe multivessel disease compared to cardiac surgery.
Abstract

Keywords:
Coronary artery diseasecoronary physiologyfractional flow reservemyocardial ischemiapercutaneous coronary intervention

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