Table 1.
Guideline | Recommendations | Recommendation Class |
---|---|---|
ACCF/AHA111 | FFR is reasonable to assess angiographically intermediate coronary artery stenosis (50–70%). | Class IIa Level of evidence A |
FFR can be useful for guiding revascularization decisions in patients with stable ischemic heart disease (SIHD). | ||
ESC/EACTS1 | FFR to identify hemodynamically relevant coronary lesion(s) in stable patients when evidence of ischemia is not available. | Class I Level of evidence A |
FFR to guide PCI in patients with MVD. | ||
SCAI112 | Definitely beneficial: | Class IIa Level of evidence B |
In SIHD, when non-invasive stress imaging is contraindicated, non-diagnostic or unavailable, FFR should be used to assess functional significance of intermediate and severe coronary stenosis (50–90%). | ||
In SIHD, PCI of lesions with FFR < 0.80 improves symptom control and decreases the need for hospitalization requiring urgent revascularization compared to medical therapy. | ||
In SIHD, medical therapy is indicated for an angiographically intermediate stenosis of unclear significant when FFR > 0.80. | ||
In patients with multivessel CAD, FFR-guided PCI improves outcomes and saves resources when compared to angiographic-guided PCI. | ||
In patients with three vessel CAD, FFR allows for reclassification of number of vessels diseased and/or SYNTAX score. | ||
No proven benefit | ||
FFR measurement of culprit vessel in patient with acute ST-segment elevation myocardial infarction or unstable acute coronary syndrome presentation should not be performed. |
Abbreviations: CAD, coronary artery disease; FFR, fractional flow reserve; MVD, multivessel disease; PCI, percutaneous coronary intervention; SIHD, stable ischemic heart disease.