Usefulness of Fractional Flow Reserve to Improve Diagnostic Efficiency in Patients With Non-ST Elevation Myocardial Infarction

Impact of Microvascular Obstruction on the Assessment of Coronary Flow Reserve, Index of Microcirculatory Resistance, and Fractional Flow Reserve After ST-Segment Elevation Myocardial Infarction

“…Use of FFR has been advocated in patients with non-STEMI(37)(38)(39) and FFR can be used to assess stenosis severity of the nonculprit artery in STEMI(16). However, there are no previous data on using FFR in the culprit artery in STEMI.…”

The instantaneous wave-free ratio (iFR) for evaluation of non-culprit lesions in patients with acute coronary syndrome and multivessel disease

“…In fact, the decision on the treatment of non-culprit vessels is always challenging, especially in patients with multivessel disease and intermediate stenoses [22][23][24]. In this regard, the use of intracoronary pressure indices would provide a complete and rapid assessment of all non-culprit lesions eventually present, allowing the identification of all ischemia-causing stenoses before the patients leave the catheterization laboratory, potentially avoiding a second procedure.…”

Beyond FAMOUS-NSTEMI

“…This visual approach has been challenged in light of the evolving and burgeoning role of FFR in stable coronary artery disease. It has been effectively demonstrated that judgments as to the haemodynamic severity of coronary stenoses performed visually are subjective and inaccurate leading to misdiagnosis and altered treatment decisions, which can be of prognostic significance [26][27][28]. In ACS, this challenge is exacerbated in multivessel disease found at angiography in trying to identify the culprit vessel as discriminating flow-limiting disease from nonculprit disease can be difficult [29].…”

“…The potential clinical utility of using FFR to guide decision-making in NSTEMI was investigated by Carrick et al [26]. They performed a retrospective study of 100 patients where FFR was used in the clinical case.…”

“…Following FFR disclosure the cardiologists were then asked to reevaluate their original decision. The use of FFR in this manner led to an increase in prescription of medical therapy and improved conformity in decisions among cardiologists [26].…”