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The measurement of the FFR – Fractional Flow Reserve and using the FFR values as a guide for further treatment in multivessel coronary artery disease improved outcomes in a multicenter trail conducted in US and Europe.  FFR – Fractional flow reserve is the ratio of the maximal blood flow in a stenotic artery to normal maximal flow. It is an index for assessment of the amount of blood that can pass through a narrowed artery. FFR in a normal artery is 1 and with stenosis (narrowing) the FFR decreases. Previous research has established that in general FFR of 0.80 or less causes ischemia (lack of adequate blood flow).

Currently the decision to place a stent in a stenotic artery is taken based solely on anatomic considerations such as size of the stenosis and degree of occlusion. In the FFR guided strategy for angioplasty, drug eluting stents are placed in stenotic lesions not based on anatomic factors but only if FFR is less than 0.80. This FFR guided strategy improved clinical outcomes.

In a randomized trail of 1005 patients with multi vessel coronary artery disease with stenosis of at least 50% of the vessel diameter in two major vessels, a group of patients underwent angioplasty based on findings in the angiography. In another group, the angioplasty was done based on the FFR measurements ( stent was placed only if FFR is less than 0.08). In the final analysis after one year, the rate of adverse events (death, heart attack, repeat revascularization) was 18.3 % in the angiography guided angioplasty group and 13.2% in the FFR guided angioplasty group. Additionally FFR guided strategy reduced the number of stents placed, with no decrease in health related quality of life.

Actionable Information
You may ask your doctor to measure the FFR while undergoing angiography.
If the FFR is greater than 0.80, you may after discussion with your doctor defer angioplasty for that particular stenotic lesion. (see the note below)

Conclusion
FFR guided angioplasty is associated with better clinical outcomes with significant reduction in adverse events. Additional benefits include reduction in costs.

Important Note:
The above information is based on the published scientific research but may not apply to your specific case. Please consult you doctor. He is your best guide. Deferring angioplasty in non-ischaemic stenotic lesion as assessed by FFR is associated with an annual rate of death or MI of approximately 1% in patients with single vessel disease. But this is less than the death or MI that occurs after routine placement of stent.

For detailed and accurate information, please visit www.nejm.org