Key result
This literature review summarizes the use and potential limitations of fractional flow reserve and instantaneous wave-free ratio for evaluating coronary stenoses in acute coronary syndromes.
This review highlights the potential limitations of FFR in ACS due to microvascular dysfunction and discusses iFR as an adenosine-free alternative for evaluating intermediate coronary stenoses.
Highlights microvascular dysfunction as a key confounder for FFR in acute coronary syndromes; leaves open.
Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events. In this literature review, we aim at summarising laboratory and clinical investigations concerning the use of FFR in culprit and non-culprit lesions in ACS. Furthermore, we will report recent data on instantaneous wave-free ratio, an adenosine-free index of functional stenosis severity, in stable coronary artery disease and in patients with ACS.
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Niccoli et al. (2017) conducted a review in Acute coronary syndromes. Fractional flow reserve (FFR) and instantaneous wave-free ratio was evaluated. This literature review summarizes the use and potential limitations of fractional flow reserve and instantaneous wave-free ratio for evaluating coronary stenoses in acute coronary syndromes.
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