CARDIOVASCULAR
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FFR—Fractional Flow Reserve

To determine the need for percutaneous coronary intervention, fractional flow reserve (FFR) is used to identify functionally significant epicardial coronary stenoses during maximal hyperemia.1

Recording and reviewing FFR measurements is straightforward when using the wireless PressureWire™ X Guidewire.

Touchscreen illustrating FFR assessment of coronary physiology

Measuring FFR

FFR is a measure of blood pressure difference across a coronary artery stenosis to determine if a stenosis is physiologically significant, which can impede oxygen delivery to the heart muscle.1

Definition of FFR:1

Pd blood flow in stenotic coronary artery

Pa blood flow in the same artery without stenosis

PressureWire™ X Guidewire measuring Pa (aortic pressure) and Pd values

Why Use FFR?

34%

of the time angiography is inaccurate

Coronary angiography is not accurate in guiding the functional significance of stenosis in 34% of cases, compared to FFR.2

35%

risk reduction in
death/MI with FFR

Line graph showing 35% risk reduction in death and myocardial infarction with FFR-guided treatment compared to angiography-guided treatment

FFR-guided percutaneous coronary intervention (PCI) leads to a 35% risk reduction in death and myocardial infarction (MI), compared to relying only on angiography.3

62%

relative risk reduction
in MACCE

Line graph showing 62% relative risk reduction in major adverse cardiac and cerebrovascular events (MACCE) at 1 year using FFR

Complete revascularization with PressureWire™ X Guidewire led to a 62% relative risk reduction in major adverse cardiac and cerebrovascular events (MACCE) at 1 year.4 The COMPARE-ACUTE trial also revealed that untreated “FFR-positive” non-infarct-related artery lesions are associated with a 31% incidence of MACCE at 1 year.4

Use of FFR vs Non-Hyperemic Pressure Ratio (RFR)?5

Uses of FFR
  Non-Hyperemic Index FFR
Left Main Coronary Artery6 - +++
Systolic Dysfunction7 - +++
Post-PCI Side Branch Interrogation8 - +++
Post-PCI Assessment9 - +++
Equivalent Assessment
Multi-Vessel Disease10 +++ +++
Diabetes11 +++ +++
Uses of Non-Hyperemic Index (RFR)
Tandem Lesions12 +++ +
Diffuse Lesions13 +++ +
Left Anterior Descending14 +++ ++
Acute Coronary Syndrome15 +++ ++

References

  1. Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334(26):1703-1708.
  2. Corcoran D, Hennigan B, Berry C. Fractional flow reserve: a clinical perspective. Int J Cardiovasc Imaging. 2017;33(7):961‐974. doi:10.1007/s10554-017-1159-2
  3. Pijls NH, Fearon WF, Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010;56(3):177‐184. doi:10.1016/j.jacc.2010.04.012
  4. Smits PC, Abdel-Wahab M, Neumann FJ, et al. Fractional flow reserve–guided multivessel angioplasty in myocardial infarction. N Engl J Med. 2017; 376:1234-1244. doi:10.1056/NEJMoa1701067.
  5. Ali Z. Invasive Assessment of Coronary Physiology Is Here to Stay! TCT 2019.
  6. Mallidi J, Atreya AR, Cook J, et al. Long-term outcomes following fractional flow reserve-guided treatment of angiographically ambiguous left main coronary artery disease: a meta-analysis of prospective cohort studies. Catheter Cardiovasc Interv. 2015;86(1):12-18.
  7. Di Gioia G, De Bruyne B, Pellicano M, et al. Fractional flow reserve in patients with reduced ejection fraction. Eur Heart J. 2020;41(17):1665-1672.
  8. Koo BK, Kang HJ, Youn TJ, et al. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol. 2005;46(4):633-637.
  9. Johnson NP, Tóth GG, Lai D, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64(16):1641-1654. doi: 10.1016/j.jacc.2014.07.973.
  10. Escaned J, Collet C, Ryan N, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J. 2017;38(42):3124-3134.
  11. DEFINE-FLAIR Trial Investigators. Comparison of major adverse cardiac events between instantaneous wave-free ratio and fractional flow reserve–guided strategy in patients with or without type 2 diabetes. JAMA Cardiol. 2019;4(9):857-864.
  12. Kikuta Y, Cook CM, Sharp ASP, et al. Pre-angioplasty instantaneous wave-free ratio pullback predicts hemodynamic outcome In humans with coronary artery disease: primary results of the International MulticenteriFR GRADIENT Registry. J Am Coll Cardiol Intv. 2018;11:757-767.
  13. Jeremias A, Davies JE, Maehara A, et al. Blinded physiological assessment of residual ischemia after uccessful angiographic percutaneous coronary intervention: the DEFINE PCI study. JACC Cardiovasc Interv. 2019;12(20):1991-2001.
  14. Sen S, Ahmad Y, Dehbi HM, et al. Clinical eventsa after deferral of LAD revascularization following physiological coronary assessment. J Am Coll Cardiol. 2019;73(4):444-453.
  15. Escaned J, Ryan N, Mejía-Rentería H, et al. Safety of the deferral of coronary revascularization on the basis of instantaneous wave-free ratio and fractional flow reserve measurements in stable coronary artery disease and acute coronary syndromes. JACC Cardiovasc Interv. 2018;11(15):1437-1449.

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