Fractional flow reserve and appropriateness of angioplasty in moderate coronary stenosis

ABSTRACT

Percutaneous coronary angioplasty [PTCA] of a coronary stenosis without documented ischemia at noninvasive stress testing is often performed, but its benefit is unproven. Coronary pressure- derived fractional flow reserve [FFR] is an invasive index of stenosis severity defined as the ratio of maximal blood pressure in a stenotic vessel to the normal maximal pressure in the same vessel. FFR is a reliable substitute for noninvasive stress testing and values below 75% identifies stenoses with hemodynamic significance. It is a method that can provide a reliable assessment of coronary stenosis especially in those with intermediate lesions. It can highly impact on decision-making in therapeutic planning and prevent many unnecessary procedures that are routinely done in these cases. In the present study, we report the results of FFR measurements in a series of patients, and this is the first report on the FFR measurement in Iran. The FFR measurement was performed for eleven vessels with intermediate stenosis, and in seven lesions [63.6%] it led to changes in the treatment strategy. On the basis of FFR, percutaneous coronary intervention [PCI] was changed into medical follow-up in five lesions, medical follow-up changed to PCI in one lesion, and coronary artery bypass grafting [CABG] changed to medical follow-up in another