All over the world, functional lesion measurement remains underutilized due to the need for a hyperemic stimulus (which may be avoided with instantaneous wave-free ratio [iFR]) and, above all, the invasiveness of guidewire placement (crossing the intended lesion) for the measurement. These guidewires have improved a lot, but they still lack the navigating capacity of...
SOLACI-SOCIME 2018 | Usefulness of the functional evaluation with iFR and FFR in bifurcations to define PCI
Read articles on the main presentations of the first day of SOLACI-SOCIME 2018 Congress. See the presentation by Dr. Flavio Ribichini, entitled “Usefulness of the functional evaluation with iFR and FFR in bifurcations to define PCI”. We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
ESC 2018 | FUTURE: A Thorn in FFR and More Questions than Answers
As observed at the preliminary analysis that motivated the FUTURE trial early termination, the use of fractional flow reserve (FFR) to guide revascularization in an unselected population with multivessel disease was associated to twice the mortality rate in one year, with no beneficial impact on other end points. Even though the combined end point of...
FFR vs Angiography Guided CABG
In the daily practice and in randomized studies such as Syntax or Freedom, most cardiovascular surgeons across the world use angiography guided CABG to teat 50% coronary stenosis. Many of these lesions might not be functionally significant. There is abundant evidence in favor of fractional flow reserve (FFR) guided PCI, but FFR guided CABG is...
EuroPCR 2018 | Compare-Acute: FFR or Primary Angioplasty at a 2-Year Follow-Up After Complete Revascularization
Recent studies in patients undergoing acute myocardial infarction showed that a complete revascularization strategy in an acute or subacute setting, whether it be guided through angiography (PRAMI, CvLPRIT) or fractional flow reserve (FFR) (PRIMULTI, COMPARE-ACUTE), improves the combined endpoint of major adverse cardiac events (MACE) when compared with treatment of the culprit artery only. Based...
EuroPCR 2018 | FFR Reduces Death and Infarction Rates Compared with Medical Treatment
Pooled data from the most important recently published studies (FAME 2, Compare-Acute, and DANAMI3-PRIMULTI) conclude that there is a significant difference in favor of fractional flow reserve (FFR) as regards hard endpoints. Coronary revascularization guided by FFR reduces the risk of death and infarction when compared with optimal medical treatment in patients with stable and...
EuroPCR 2018 | FAME 2: FFR Shows 5-Year Benefit for Hard Endpoints
After a 5-year follow-up, and for the first time, functional assessment with fractional flow reserve (FFR) showed clear benefit for a hard endpoint: acute myocardial infarction. Use of FFR in patients with stable coronary artery disease so as to identify hemodynamically significant lesions in order to restrict angioplasty treatment to them has long-term benefits compared...
EuroPCR 2018 | SCAAR Registry at 10 years: FFR improves decision making in the long term
The SCAAR registry aimed at showing the differences in mortality at very long term when using functional assessment of coronary lesions (with FFR or iFR) in patients with chronic stable angina. The study compared 3460 patients assessed with FFR/iFR against 21221 patients undergoing PCI based on angiography, between January 2005 and March 2015. As...
Routine FFR/iFR Reclassifies Treatment Strategies in Half of Cases
Routine invasive physiology assessment at time of angiography reclassifies treatment strategies in a big number of patients with lesions in 2 or 3 vessels, according to the multicenter prospective study DEFINE REAL, recently published in JACC Cardiovascular Interventions. The information obtained by measuring fractional flow reserve (FFR) or instantaneous wave free ratio (iFR) made interventionists modify their original plans in...
The diagnostic performance of the iFR makes the FFR tremble
Despite the evidence, most stable patients continue to be managed based on coronary angiography and, worse, often without a prior non-invasive functional study. With the introduction of the FFR, we left the “anatomical” era for the “functional” era in the catheterization room, which has been proven to improve patients prognosis and, as if that were...