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. 2016 May;11(1):17-26.
doi: 10.15420/icr.2016:7:2.

Fractional Flow Reserve: Does a Cut-off Value add Value?

Shah R Mohdnazri  1   2 , Thomas R Keeble  1   2 , Andrew Sp Sharp  3   4
Affiliations

Fractional Flow Reserve: Does a Cut-off Value add Value?

Shah R Mohdnazri et al. Interv Cardiol. 2016 May.

Abstract

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a 'grey zone' for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

Keywords: Coronary physiology; fractional flow reserve; pressure wire.

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Conflict of interest statement

Disclosure: SRM and TRK have received research support from Volcano Corporation. ASPS has received consultancy fees from Volcano Corporation.

Figures

Figure 1:
Figure 1:. Myocardial Ischaemia is a Result of a Complex Multifactorial Pathophysiological Mechanism
Figure 2:
Figure 2:. Summary of the DEFER Study Design
Figure 3:
Figure 3:. Summary of the FAME Study Design
Figure 4:
Figure 4:. Summary of the FAME-2 Study Design.
Figure 5:
Figure 5:. An Illustration of How Many Patients Would Have Been Required in the FAME-2 Study to Show Difference in Rates of Death and/or MI
Figure 6:
Figure 6:. Schematic Diagram Illustrating Coronary Physiology Measurement Zones
See this image and copyright information in PMC

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