Key result
FFR and iFR guide SIHD revascularization but require caution in ACS and altered hemodynamic states.
Why the study?
The role of coronary physiology testing is less clear among specific patient subsets, including those with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, and post-percutaneous coronary interventions.
Does physiological assessment of coronary lesions using FFR or iFR improve clinical outcomes in specific patient groups such as those with ACS, post-PCI, or serial lesions?
Does physiological assessment of coronary lesions using FFR or iFR improve clinical outcomes in specific patient groups such as those with ACS, post-PCI, or serial lesions?
This review highlights the evolving role and current evidence gaps for coronary physiology testing (FFR/iFR) in complex clinical scenarios such as ACS, post-PCI assessment, and serial lesions.
Supports cautious FFR/iFR use outside stable ischemic heart disease; leaves open definitive outcome trials in ACS, post-PCI, and serial lesions.
Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain patients' groups, including patients with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, as well as post-percutaneous coronary interventions. In this review, we aimed to discuss the utility and clinical evidence of coronary physiology (mainly FFR and iFR), with emphasis on those specific patient groups.
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Elbadawi et al. (2023) conducted a review in Coronary artery disease (stable ischemic heart disease, acute coronary syndrome, aortic stenosis, heart failure). Coronary physiology testing (FFR and iFR) vs. Angiography-guided management was evaluated. Coronary physiology testing with FFR and iFR effectively guides revascularization in stable ischemic heart disease, but its utility in acute coronary syndromes, post-PCI, serial lesions, and aortic stenosis requires careful interpretation due to altered hemodynamics.
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