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FFR-guided Revascularisation — EECC MCQ

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EasyCoronary Artery DiseaseFFR-guided RevascularisationEECC

A 62-year-old man with stable angina undergoes invasive coronary angiography. The operator performs FFR measurement of a 60% LAD stenosis. The FFR value is 0.78. What does this indicate and what is the recommended management?

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Correct answer: E — FFR ≤0.80 indicates a haemodynamically significant lesion; revascularisation (PCI or CABG) improves outcomes compared with medical therapy alone based on the FAME trials

Fractional flow reserve (FFR) measures the ratio of distal coronary pressure to aortic pressure during maximal hyperaemia (induced by adenosine). An FFR ≤0.80 indicates haemodynamic significance — the stenosis causes a ≥20% reduction in maximal blood flow. The FAME trial demonstrated that FFR-guided PCI (treating only lesions with FFR ≤0.80) reduced death, MI, and repeat revascularisation compared with angiography-guided PCI. The FAME 2 trial showed FFR-guided PCI plus medical therapy was superior to medical therapy alone for FFR ≤0.80 lesions. The 2024 ESC CCS Guidelines recommend FFR or iFR for physiological assessment of intermediate stenoses (Class I, LOE A). iFR (instantaneous wave-free ratio) uses a resting measurement with a threshold of ≤0.89.

Reference: ESC (2024): CCS Guidelines; FAME/FAME 2 Trials