Fractional flow reserve for all coronary lesions with intermediate stenosis, a step towards optimal PCI – Single centre experience in India

Visual assessment of intermediate coronary lesions (ICL) is fraught with errors. FFR guided PCI is often advocated but runs a potential risk of disease progression and residual ischemia. To assess accuracy of visual estimation in ICL, using FFR and comparing clinical outcomes in patients with all interrogated lesions revascularized or otherwise. Consecutive patients undergoing PCI between September 2010 and 2012, who had one or more of ICL, were subjected to FFR and PCI was performed if FFR was 0.80 or less. Post-revascularization patients were divided in two groups, group I consisting of patients in whom all interrogated lesion had a significant FFR value and revascularized and group II consisting of patients with one or more non-significant lesions on FFR and left non-revascularized. The clinical end points of angina, number of anti-anginal medications prescribed and repeat revascularization were assessed at 6 months. 74 patients had FFR done in 104 of ICL (30–80% on visual estimation) of which 37 (35.5%) lesions were considered significant (>50% diameter stenosis) by visual estimation. On confirmation with FFR visual estimation had predictive accuracy of only 57%. 87% of the patients in the group I, were free from angina, whereas 84.4% in the group II (P = 0.46) at 6 months. Also need for repeat revascularization was similar in both groups 2.5% and 2.85% respectively (P = 0.82). Visual estimation has poor predictive accuracy in of ICL and FFR guided PCI gives good clinical outcomes, without any increase of events in interrogated but non-revascularized patients.