Abstract and Introduction
Introduction
Rare are the approaches that have changed our understanding of coronary artery disease as has fractional flow reserve (FFR). After extensive animal and human validation work and hypothesis-generating observational studies,[1] larger randomized trials with a superiority design have reshaped our therapeutic strategies in stable coronary artery disease and, albeit to a lesser extent, of acute coronary syndromes. In a nutshell: (1) stenoses with an FFR >0.80 do not benefit from revascularization, not even the nonculprit vessels in patients with acute coronary syndromes;[2,3] (2) patients with ≤1 stenosis with an FFR ≤0.80 are better off with contemporary percutaneous coronary intervention than with medical therapy;[4] (3) the angiographic 50% diameter stenosis is a battered standard to define coronary artery disease, risk stratify patients, or guide therapy;[5,6] (4) performing FFR during diagnostic angiography modifies about half of the revascularization decisions;[7] and (5) there is a risk continuum for FFR over the entire range of stenosis severity.[8,9]
Therefore, one might wonder what an observational database could add to this knowledge. The results of the IRIS-FFR registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) published in this issue of Circulation[10] largely confirm the points listed here, but this confirmation is welcome for several reasons.
Circulation. 2017;135(23):2252-2254. © 2017 American Heart Association, Inc.
