A 68-year-old woman with stable angina has an FFR (fractional flow reserve) of 0.79 on invasive angiography of a 60% LAD stenosis. She is on optimal medical therapy. What does this FFR value indicate and what is the next step?
- A Haemodynamically significant stenosis; proceed to PCI ✓
- B Non-significant stenosis; continue medical therapy
- C Indeterminate result; repeat FFR after nitrate infusion
- D Borderline stenosis; CABG is preferred over PCI
Correct answer: A. Haemodynamically significant stenosis; proceed to PCI
Explanation
FFR ≤0.80 defines haemodynamically significant coronary stenosis; PCI guided by FFR has been shown (DEFER, FAME, FAME-2 trials) to improve outcomes compared to angiography-guided PCI. FFR of 0.79 falls below the 0.80 cut-off, indicating ischaemia-producing stenosis that benefits from revascularisation. An FFR >0.80 would favour continued medical therapy. There is no role for re-testing after nitrate for an FFR value already below threshold.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.