OPINION
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 5-12

Insights into the role of fractional flow reserve in clinical practice


Singapore Heart, Stroke and Cancer Center, Singapore

Correspondence Address:
Prof. Michael Chun-Leng Lim
Singapore Heart, Stroke and Cancer Centre
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cp.cp_7_20

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The early trials of fractional flow reserve (FFR), such as the Deferral versus Performance of Percutaneous Transluminal Coronary Angioplasty in Patients Without Documented Ischaemia, FFR versus angiography for multivessel evaluation (FAME), and FAME 2 trials, established the role of FFR in the practice of interventional cardiology. These trials led proponents of FFR to propose making FFR a routine procedure before percutaneous coronary intervention (PCI) and to give preference to PCI over optimal medical therapy (OMT) in those with FFR-positive coronary stenoses. Follow-up results of these trials have given more insights. Some of the benefits of FFR-guided strategy over angiography-guided strategy disappeared over time, and beyond revascularization, the FFR strategy did not show benefit over OMT when considering death and myocardial infarction as endpoints. The FUnctional Testing Underlying Coronary REvascularization trial did not demonstrate the superiority of the FFR-guided strategy over angiography-guided strategy. The ORBITA and the ISHEMIA trials gave strength to the lifestyle modification and OMT approach in stable ischemic heart disease patients with moderate-to-severe ischemia. The role of FFR has to be defined in light of the evolving clinical advances in medicine and new evidence. An in-depth review of all current evidence provides no compelling evidence for the routine use of FFR in cardiac interventions. However, FFR can play a role in coronary stenoses where there is uncertainty in the hemodynamic impact of the lesions.


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