Fractional flow reserve (FFR)-guided revascularization is superior to angiography, while the instantaneous wave-free ratio (iFR) demonstrates non-inferiority to FFR for clinical outcomes.
What is the role of physiologic indices like FFR and iFR in guiding revascularization for coronary artery disease, and how do we address unresolved issues like index discordance and microvascular dysfunction?
This review summarizes current evidence and unresolved issues regarding the use of physiologic indices like FFR and iFR for guiding coronary revascularization.
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The presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease, and ischemia-directed revascularization has been a standard of care. Fractional flow reserve (FFR) is an invasive method used to detect the functionally significant epicardial coronary stenosis, and FFR-guided revascularization strategy has been proven to be superior to angiography-guided strategy. Recently, a hyperemia-free index, instantaneous wave free ratio (iFR), was developed and showed its non-inferiority for clinical outcomes compared with FFR-guided strategy. While evidence supporting the benefit of pressure wire assessment exists, there remain several unresolved issues, such as the mechanism of discordance between resting and hyperemic physiologic indices, clinical outcomes of patient/lesions with discordant results among the physiologic indices, role of physiologic indices beyond per-vessel decision tool, and the role of microvascular dysfunction in patient prognosis. The current article will review the recent studies performed to address these questions.
Lee et al. (Mon,) reported a other. Fractional flow reserve (FFR)-guided revascularization is superior to angiography, while the instantaneous wave-free ratio (iFR) demonstrates non-inferiority to FFR for clinical outcomes.