What's the Best Way to Guide Revascularization in Patients with Stable Coronary Lesions?

In two studies, guidance with fractional flow ratio or with a simplified, adenosine-free strategy provided a similar primary benefit, but adverse effects may differ.

Evidence is increasing that coronary revascularization guided with fractional flow ratio (FFR) in patients with predominantly stable coronary artery disease (CAD) improves clinical outcomes, with benefits even found in non–infarct-related arteries in patients with ST-segment elevation myocardial infarction (STEMI; NEJM JW Cardiol Mar 18 2017; [e-pub] and N Engl J Med 2017 Mar 18; [e-pub]). Despite mounting evidence and guideline recommendations, adoption of FFR-guided revascularization has been limited, mainly due to logistical challenges like the prolonged procedure time and adverse effects (bradycardia, heart block, dyspnea, and chest pain) of adenosine, which is necessary to achieve a hyperemic state. A simplified approach — especially i…

Reviewing Author

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Leadership Positions in Professional SocietiesEuropean Society of Cardiology (Communication Committee); European Association of Percutaneous Cardiovascular Interventions (Chair, Web & Communication Committee)

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

What's the Best Way to Guide Revascularization in Patients with Stable Coronary Lesions?

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Reviewing Author