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Abstract
Fractional flow reserve (FFR) is a reference invasive diagnostic test to assess the physiological significance of an epicardial coronary artery stenosis. FFR-guided percutaneous coronary intervention in stable coronary artery disease has been assessed in three seminal clinical trials and the indications for FFR assessment are expanding into other clinical scenarios. In this article we review the theoretical, experimental and clinical basis for FFR measurement. We place FFR measurement in the context of the comprehensive invasive assessment of coronary physiology in patients presenting with known or suspected angina pectoris in daily clinical practice, and review the recent developments in FFR assessment.
Highlights
Coronary artery disease (CAD) is a significant cause of morbidity and mortality worldwide [1]
In study of 1000 patients who underwent invasive coronary angiography (ICA), intra-vascular ultrasound (IVUS), and Fractional flow reserve (FFR), it was determined that quantitative coronary angiography (QCA) had a diagnostic accuracy of 66% compared with FFR
The results were consistent with those of RIPCORD, with the frequent reclassification of management with FFR-guided management compared to visual interpretation of the angiogram alone (47% of the cases). This evidence suggests that routine use of FFR at the diagnostic stage may improve the treatment decisionmaking for patients by correctly identifying functionally significant coronary lesions facilitating lesion-level tailored management. Whether this will result in improved clinical outcomes will be answered by a number of ongoing studies: The proposed RIPCORD 2 study [70] will randomise 1100 patients presenting with chest pain who are scheduled to undergo ICA to angiography-guided management or FFR-guided management; The Functional Testing Underlying Coronary Revascularisation (FUTURE) trial (NCT01881555) will randomise 1728 patients chest pain with multi-vessel coronary artery disease diagnosed on ICA, to angiography alone versus angiography and FFRguided care, with a composite primary end point of death, myocardial infarction (MI), coronary revascularisation, and stroke at 1 year
Summary
Coronary artery disease (CAD) is a significant cause of morbidity and mortality worldwide [1]. This evidence suggests that routine use of FFR at the diagnostic stage may improve the treatment decisionmaking for patients by correctly identifying functionally significant coronary lesions facilitating lesion-level tailored management Whether this will result in improved clinical outcomes will be answered by a number of ongoing studies: The proposed RIPCORD 2 study [70] will randomise 1100 patients presenting with chest pain who are scheduled to undergo ICA to angiography-guided management or FFR-guided management; The Functional Testing Underlying Coronary Revascularisation (FUTURE) trial (NCT01881555) will randomise 1728 patients chest pain with multi-vessel coronary artery disease diagnosed on ICA, to angiography alone versus angiography and FFRguided care, with a composite primary end point of death, MI, coronary revascularisation, and stroke at 1 year. Exciting new studies, including ADVANCE and SYNTAX III, will probe the expanding clinical potential and utility of this technology [98, 99]
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