Guidelines

Recommendations

2018 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) [15]

· FFR is the current standard of care for the functional assessment of lesion severity in patients with intermediate-grade stenosis (typically around 40% - 90% stenosis) without evidence of ischemia in non-invasive testing or those with multivessel disease.

· FFR may also be useful for the selection of lesions requiring revascularization in patients with multivessel CAD.

2016 and 2017 ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease [16]

· Invasive measurements (such as FFR) may be very helpful in further defining the need for revascularization and may substitute for stress test findings.

· FFR ≤ 0.80 is abnormal and is consistent with downstream inducible ischemia.

· Appropriate use criteria advocate for expanded use of intracoronary physiologic testing.

· In the presence of an asymptomatic intermediate-severity non-culprit artery stenosis, revascularization was rated as an “appropriate therapy,” provided that the FFR was ≤0.80.

Society of Cardiovascular Angiography and Interventions: Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: A consensus statement of the Society of Cardiovascular Angiography and Interventions [17]

· In SIHD when noninvasive imaging is unavailable, nondiagnostic, or discordant, FFR should be used to assess the functional significance of intermediate-severe coronary stenosis (50% - 90%).

· In SIHD, PCI of lesions with FFR < 0.80 improves symptom control and decreases urgent revascularization compared to medical therapy.

· When FFR > 0.80 in angiographically intermediate lesions with SIHD, medical therapy is indicated.