FFR as a clinical tool and its applications in specific scenarios

Fractional flow reserve (FFR) is an invasive technique used to assess the hemodynamic impact of epicardial coronary artery stenosis, ultimately guiding revascularization. There is significant clinical evidence supporting FFR, but as with any technique, it has subtleties that are important to appreciate when deciding upon the treatment strategy for a given lesion. The background and methodology for measurement of FFR are described in other chapters in this book. In this chapter we will focus on the utility of FFR in situations frequently encountered in the catheterization laboratory and the main clinical evidence to support and guide its use. In general, ischemia-directed revascularization based on FFR has demonstrated better outcomes in most clinical and angiographic settings. When compared to angiographically guided decisions, FFR frequently leads to a reduction in unnecessary procedures, and it appears to have a favorable economic profile. Notwithstanding its limitations, it has changed the face of clinical practice, allowing a comprehensive physiology-based evaluation, rather than the insufficient luminography-based precedent. It is expected that in the future, a greater proportion of patients will be treated based on functional assessment (with FFR or other techniques) which will likely lead to improved clinical results.