July 26, 2018 — The Society of Cardiac Angiography and Interventions (SCAI) released a focused update expert consensus statement in July for the use of invasive coronary physiological assessments. It recommends either fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) technologies can be used to assess the hemodynamic significance of coronary lesions to determine if a stent is needed. The statement said physiologicaly guided percutaneous coronary intervention (PCI) results in better clinical outcomes and saves resources compared to angiographic image guidance alone.
Both iFR and FFR are deemed “definitely beneficial” for assessing the functional significance of intermediate coronary stenoses when noninvasive stress imaging is not available or does not provide a definitive answer. SCAI sees probable benefits when FFR or iFR are used to reclassify the number of vessels that are diseased in patients with multivessel disease.
SCAI’s updated consensus statement was published in the SCAI journal Catherization and Cardiovascular Interventions. Based on the data from the DEFINE-FLAIR and iFR Swedeheart trials showing that the technique is noninferior to FFR for guiding decisions about intervening on intermediate lesions in patients with stable angina or non-STEMI acute coronary syndrome (ACS).[2,3]
The authors also spend some time covering the utility of iFR and/or FFR in stable ischemic heart disease, multivessel coronary artery disease (CAD), left main coronary stenosis, ACS, STEMI, aortic stenosis, tandem and serial lesions, and bypass grafts.
Related FFR and iFR Content:
1. Amir Lotfi, Justin E. Davies, William F. Fearon, et al. Focused update of expert consensus statement: Use of invasive assessments of coronary physiology and structure: A position statement of the society of cardiac angiography and interventions, First published: 03 July 2018 https://doi.org/10.1002/ccd.27672
3. Matthias Götberg, Evald H. Christiansen, Ingibjörg J. Gudmundsdottir, et al. Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. N Engl J Med 2017; 376:1813-1823. DOI: 10.1056/NEJMoa1616540