Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis

Abstract

Five-year outcome after deferral of PCI of an intermediate coronary stenosis based on FFR >/=0.75 is excellent. The risk of cardiac death or myocardial infarction related to this stenosis is <1% per year and not decreased by stenting.

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

“…FFR and CFR are both well‐validated physiological indices for guiding PCI indication 2, 3, 4, 11. A recent study also suggested that FFR measured after PCI has prognostic value, with an inverse relationship to subsequent clinical events 5.…”

“…Fractional flow reserve (FFR) is the standard in decision making for revascularization in the catheter laboratory and has become a part of the clinical guidelines for assessing the physiological significance of epicardial coronary stenosis based on a sound concept and randomized clinical trials 1, 2, 3, 4. A recent study also suggested that FFR measured after percutaneous coronary intervention (PCI) has prognostic value, with an inverse relationship to subsequent clinical events 5.…”

“…A recent study also suggested that FFR measured after percutaneous coronary intervention (PCI) has prognostic value, with an inverse relationship to subsequent clinical events 5. The purpose of PCI is to increase coronary flow by modifying epicardial stenosis, and FFR‐guided PCI results in better outcome compared with angiographic guidance,2, 3 suggesting that FFR‐guided PCI may benefit from hyperemic coronary flow increase. Recently, recognition of the significant relevance of myocardial blood flow with adverse clinical outcome urges a comprehensive approach to ischemic heart disease with incorporation of coronary flow impairment and microvascular resistance as well as FFR 6, 7, 8, 9, 10.…”

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

“…However, cumulative evidence suggests that angiographically determined anatomical stenosis severity often underestimates or overestimates the functional significance of lesions 5, 6, 7. Fractional flow reserve (FFR) is currently the standard for decision‐making regarding revascularization in the catheter laboratory and has become part of the clinical guidelines for the assessment of the physiological significance of epicardial coronary stenosis based on sound concepts and randomized clinical trials 8, 9, 10, 11. However, FFR evaluation is still underutilized; instead, coronary angiography is widely used as a gatekeeper for decision‐making of revascularization even in large clinical trials 2, 12.…”

Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging

“…cSE‐WMP results might be useful for the decision to revascularize or not, similar to what fractional flow reserve (FFR) studies have recently proposed 26, 27, 28. Our findings point in the same direction to what has been observed with invasive FFR; such multicenter studies prospectively demonstrated that FFR is prognostically useful to proceed to revascularization, but in patients already selected to undergo diagnostic coronary angiography, although they fell short of demonstrating a benefit regarding hard events, death and MI, since in the FAME 2 study (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) the FFR‐guided percutaneous coronary revascularization arm was favored on comparison of the primary composite end point of death, MI, and target vessel revascularization, but such finding was driven by urgent target vessel revascularization 28, 29.…”