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Deferred PCI for Non-significant FFR — EECC MCQ

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EasyCoronary Artery DiseaseDeferred PCI for Non-significant FFREECC

A 62-year-old man with stable angina and diabetes undergoes CTCA showing a 70% mid-LAD stenosis. His cardiologist recommends invasive angiography with FFR. The FFR is 0.83. What is the recommended management?

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Correct answer: D — Medical therapy alone — FFR >0.80 indicates the lesion is not haemodynamically significant and PCI does not improve outcomes compared with optimal medical therapy

An FFR >0.80 indicates that the stenosis does not cause significant flow limitation during maximal hyperaemia. The FAME 2 trial demonstrated that deferring PCI in lesions with FFR >0.80 is safe, with outcomes equivalent to medical therapy alone. The DEFER trial (15-year follow-up) confirmed that deferred lesions with FFR >0.75 had excellent long-term outcomes. This applies even when angiographic stenosis appears moderate-severe (50-70%). The 2024 ESC CCS Guidelines recommend FFR/iFR-guided PCI decisions (Class I) — physiological significance, not anatomical appearance, should drive revascularisation. Medical therapy should be optimised (antiplatelet, statin, anti-anginal, risk factor control).

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