Fractional Flow Reserve: Patient Selection and Perspectives

Figures & data

Table 1 Current Guidelines for FFR

Guideline	Recommendations	Recommendation Class
ACCF/AHA^Citation111	FFR is reasonable to assess angiographically intermediate coronary artery stenosis (50–70%).	Class IIa Level of evidence A
	FFR can be useful for guiding revascularization decisions in patients with stable ischemic heart disease (SIHD).
ESC/EACTS^Citation1	FFR to identify hemodynamically relevant coronary lesion(s) in stable patients when evidence of ischemia is not available.	Class I Level of evidence A
	FFR to guide PCI in patients with MVD.
SCAI^Citation112	Definitely beneficial:	Class IIa Level of evidence B
	In SIHD, when non-invasive stress imaging is contraindicated, non-diagnostic or unavailable, FFR should be used to assess functional significance of intermediate and severe coronary stenosis (50–90%).
	In SIHD, PCI of lesions with FFR < 0.80 improves symptom control and decreases the need for hospitalization requiring urgent revascularization compared to medical therapy.
	In SIHD, medical therapy is indicated for an angiographically intermediate stenosis of unclear significant when FFR > 0.80.
	In patients with multivessel CAD, FFR-guided PCI improves outcomes and saves resources when compared to angiographic-guided PCI.
	In patients with three vessel CAD, FFR allows for reclassification of number of vessels diseased and/or SYNTAX score.
	No proven benefit
	FFR measurement of culprit vessel in patient with acute ST-segment elevation myocardial infarction or unstable acute coronary syndrome presentation should not be performed.

Abbreviations: CAD, coronary artery disease; FFR, fractional flow reserve; MVD, multivessel disease; PCI, percutaneous coronary intervention; SIHD, stable ischemic heart disease.

Figure 1 Overview of the different non and less invasive FFR techniques. (A) Example of a non-hyperemic pressure ratio measurement (iFR) of the RCA. (B) Example of angiography-based FFR (QFR) of the LAD. (C) Two examples of CT based FFR (left panel: HeartFlow FFR-CT, right panel: Philips CT-FFR).

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