This expert consensus document summarizes clinical data and provides practical recommendations for performing and interpreting FFR measurements to guide coronary revascularization.
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Supports FFR-guided revascularization decisions in practice; reinforces Level 1 evidence in updated consensus guidelines.
Fractional flow reserve (FFR) measurements can determine the haemodynamic relevance of coronary artery stenoses. Current guidelines recommend their use in lesions in the absence of non-invasive proof of ischaemia. The prognostic impact of FFR has been evaluated in randomised trials, and it has been shown that revascularisation can be safely deferred if FFR is >0.80, while revascularisation of stenoses with FFR values ≤0.80 results in significantly lower event rates compared to medical treatment. Left main stenoses, aorto-ostial lesions, as well as patients with left ventricular hypertrophy and severely-impaired ejection fraction, have been excluded from large, randomised trials. While FFR measurements are relatively straightforward to perform, uncertainty about procedural logistics, as well as data acquisition and interpretation in specific situations, could explain why they are not widely used in clinical practice. We summarise the clinical data in support of FFR measurements, and provide recommendations for performing and interpreting the procedure.
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Achenbach et al. (2017) conducted a review in Coronary artery stenoses. Fractional flow reserve (FFR) measurements was evaluated. Fractional flow reserve (FFR) measurements safely guide revascularization deferral when >0.80, while revascularization of stenoses with FFR ≤0.80 results in significantly lower event rates.
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