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Coronary Physiology - FFR/iFR — EECC MCQ

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HardCoronary Artery DiseaseCoronary Physiology - FFR/iFREECC

A 62-year-old man with stable angina undergoes coronary angiography showing a 60% stenosis in the mid-LAD. The interventional cardiologist performs pressure wire assessment. The instantaneous wave-free ratio (iFR) is 0.88 and fractional flow reserve (FFR) is 0.78. What is the most appropriate management?

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Correct answer: C — PCI to the LAD as both iFR and FFR are below their respective treatment thresholds

For an intermediate coronary stenosis, invasive physiological assessment is used to determine whether the lesion is flow-limiting and should be revascularised. The accepted ischaemic thresholds are FFR ≤0.80 and iFR ≤0.89. This patient’s mid-LAD lesion has iFR 0.88 and FFR 0.78, so both indices are positive. The most appropriate management is PCI to the LAD. Option D is not the best answer because FFR does not need to “take precedence” here: the results are concordant. Option A is incorrect because iFR 0.88 is below, not above, the treatment threshold. CABG is not indicated for an isolated 60% mid-LAD lesion without left main, proximal LAD high-risk anatomy, or multivessel disease.

Reference: 2024 ESC Guidelines for the management of chronic coronary syndromes, European Heart Journal 2024;45:3415–3537. https://academic.oup.com/eurheartj/article/45/36/3415/7743115