Should we be using fractional flow reserve more routinely to select stable coronary patients for percutaneous coronary intervention?

PURPOSE OF REVIEW: To address the clinical benefit of fractional flow reserve (FFR) measurement in stable coronary artery disease (CAD) patients. RECENT FINDINGS: The efficacy of revascularization in patients with stable CAD has been debatable. However, there has been consensus that revascularization for ischemic-producing lesions may improve clinical outcomes. FFR is considered nowadays as the gold standard for the invasive assessment of ischemic potential of intermediate coronary artery stenosis. Intermediate stenosis with FFR of greater than 0.80 has been demonstrated to be safely deferred with annual event rate less than 1%. Recently, preliminary data of FAME II trial presented that revascularization for stenosis with FFR of 0.80 or less has clinical benefits over optimal medical treatment with respect to the reduction of unplanned hospitalization and urgent revascularization in stable CAD patients. A large randomized controlled trial demonstrated that FFR-guided percutaneous coronary intervention (PCI) improved clinical outcomes while reducing the medical costs in multivessel CAD. Therefore, current guidelines recommend the consideration of FFR measurements as level of evidence 'A' when the ischemic potential for specific target lesions is questionable. SUMMARY: Much clinical evidence indicates that use of this dedicated invasive functional method may help in selecting appropriate patients and lesions for treatment, avoiding unnecessary procedures, reducing medical costs, and improving each patient's clinical outcomes. Therefore, we should use FFR more routinely to select stable coronary patients for PCI.