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Angiographic results alone can guide the decision to perform a percutaneous coronary intervention (PCI). Angiography is used to visually assess the coronary anatomy and determine the degree of stenosis, plaque, or blockage in the coronary artery. The blockage creates visual irregularities of the inner diameter of coronary vessels on angiography, and those irregularities are quantified using a percentage. This percentage correlates with the degree of blockage of the artery. The degree of blockage is usually quantified with a percentage and categorized into mild, moderate/intermediate, or severe. This activity describes the quantification of blockages in the coronary artery using the fractional flow reserve method. Objectives: Identify the technique of measuring fractional flow reserve. Determine how the fractional flow reserve is calculated. Identify the clinical significance of measuring the FFR. Communicate interprofessional team strategies for improving care coordination and communication to advance the quantification of coronary artery stenosis and improve outcomes. Access free multiple choice questions on this topic.

Angiographic results alone can guide the decision to perform a percutaneous coronary intervention (PCI). Angiography is used to visually assess the coronary anatomy and determine the degree of stenosis, plaque, or blockage in the coronary artery. The blockage creates visual irregularities of the inner diameter of coronary vessels on angiography, and those irregularities are quantified using a percentage. This percentage correlates with the degree of blockage of the artery. The degree of blockage is usually quantified with a percentage and categorized into mild, moderate/intermediate, or severe.[1][2][3][4] The assessment of intermediate blockages in coronary artery disease has long been a challenge for interventional cardiologists to determine the appropriate use of angioplasty and stenting. Fractional Flow Reserve (FFR) offers yet another tool to assist in identifying those intermediate blockages. The goal of angioplasty and stenting in the coronary arteries is to increase blood flow to the heart and relieve chest pain. However, studies have shown that if a functional measurement, such as FFR, shows that the flow is not significantly blocked, the blockage or lesion does not need to be revascularized (angioplasty/stenting), and a physician can treat the patient with medical therapy safely. FFR is a guide wire-based procedure that accurately measures blood pressure and flow through an isolated coronary artery segment. A physician can do FFR through a standard diagnostic catheter during a coronary angiogram or cardiac catheterization. FFR has been demonstrated to be useful in assessing “intermediate” blockages (coronary artery disease) to determine the need for angioplasty or stenting (See Image. Fractional Flow Reserve Procedure).[5][6][7][8]

The Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME, 2009) compared patients undergoing routine PCI for stable multivessel CAD to FFR-guided or angiography-guided PCI, with both groups on OMT. FAME (2009) demonstrated that FFR was superior to traditional angiography-guided PCI among patients with stable multivessel CAD, demonstrating lower 1-year adverse events and reduced costs. This trial paved the way for continued study and evaluation of FFR capability compared to OMT, as demonstrated in the COURAGE (2007) trial. Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2 (FAME 2, 2011) studied the role of PCI among patients with stable single or multivessel CAD with physiologically significant coronary lesions. In contrast to FAME, FAME 2 focused on patients with FFR less than or equal to 0.80, comparing PCI to OMT alone. Among patients with stable CAD with FFR less than or equal to 0.80, PCI demonstrated overall better outcomes concerning death, nonfatal MI, and urgent revascularization. The preponderance of clinical trial evidence for FFR-driven revascularization prompted the incorporation of FFR into the 2011 American College of Cardiology (ACC)/American Heart Association (AHA) and 2014 European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Guidelines.