Guest Editorial: Controversies in Fractional Flow Reserve

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Diagnostic imaging

Background:

• Fractional flow reserve (FFR) has been considered the gold standard for assessing significant coronary artery lesions.
• The COURAGE trial has influenced current diagnostic strategies for coronary artery disease.
• There is an ongoing need for cost-effective and accurate diagnostic tools in cardiology.

Purpose of the Study:

• To evaluate the diagnostic accuracy and cost-effectiveness of Fractional flow reserve (FFR) in identifying significant coronary lesions.
• To reassess the role of FFR in light of recent clinical trial evidence.
• To explore alternative diagnostic strategies for coronary artery disease.

Main Methods:

• Review of current evidence and clinical trial data regarding FFR accuracy.
• Analysis of sensitivity and specificity of FFR compared to other diagnostic modalities.
• Cost-effectiveness analysis of FFR in the context of post-COURAGE trial guidelines.

Main Results:

• Current evidence does not support FFR as the optimal diagnostic tool for significant coronary lesions.
• The diagnostic performance of FFR in terms of sensitivity and specificity is questionable.
• The cost-effectiveness of FFR is a significant concern in current clinical practice.

Conclusions:

• FFR's role as the optimal diagnostic tool for significant coronary lesions is not supported by current evidence.
• The development of highly sensitive, specific, and cost-effective diagnostic strategies remains a challenge.
• Further research is needed to establish optimal diagnostic pathways for coronary artery disease.