Real-Life Fractional Flow Reserve

• Editorials
• coronary artery disease
• flow measurement
• fractional flow reserve
• percutaneous transluminal coronary angioplasty
• medication therapy

Article, see p 2241

Rare are the approaches that have changed our understanding of coronary artery disease as has fractional flow reserve (FFR). After extensive animal and human validation work and hypothesis-generating observational studies,¹ larger randomized trials with a superiority design have reshaped our therapeutic strategies in stable coronary artery disease and, albeit to a lesser extent, of acute coronary syndromes. In a nutshell: (1) stenoses with an FFR >0.80 do not benefit from revascularization, not even the nonculprit vessels in patients with acute coronary syndromes^2,3; (2) patients with ≤1 stenosis with an FFR ≤0.80 are better off with contemporary percutaneous coronary intervention than with medical therapy⁴; (3) the angiographic 50% diameter stenosis is a battered standard to define coronary artery disease, risk stratify patients, or guide therapy^5,6; (4) performing FFR during diagnostic angiography modifies about half of the revascularization decisions⁷; and (5) there is a risk continuum for FFR over the entire range of stenosis severity.^8,9

Therefore, one might wonder what an observational database could add to this knowledge. The results of the IRIS-FFR registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) published in this issue of Circulation^{10 …}