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The Role of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Measurements in Patients with Acute Coronary Syndrome

  • Management of Acute Coronary Syndromes (H Jneid, Section Editor)
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Abstract

Purpose of Review

The role of fractional flow reserve to guide revascularization in patients with stable angina is well established. The instantaneous wave-free ratio (iFR) is an emerging adenosine-free resting index that is non-inferior to FFR and has potential to streamline the functional evaluation of coronary artery disease. The feasibility and utility of intracoronary physiology in patients with acute coronary syndrome (ACS) is unclear. This review will discuss the physiological principles and validity of using FFR and iFR in patients presenting with ACS. We will also provide an overview of the available evidence for their role in guiding revascularization in this patient group.

Recent Findings

The use of intracoronary physiology in culprit lesions of patients presenting with STEMI is not recommended and its accuracy is uncertain in patients with NSTEMI. In contrast, the physiological assessment of non-culprit vessels with FFR and IFR is a reliable measure of lesion-specific ischemia. Recent studies have demonstrated that FFR-guided revascularization of non-culprit lesions improves clinical outcomes although the role of iFR in this patient cohort is unknown.

Summary

Physiology-guided revascularization of non-culprit ACS lesions improves clinical outcomes. Future studies investigating the complementary role of plaque morphology, biomechanics, and systemic inflammation may provide clinicians with a more comprehensive framework to guide treatment decisions.

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Authors and Affiliations

  1. Monash Cardiovascular Research Centre and MonashHeart, Monash University and Monash Health, Melbourne, Australia

    Abdul Rahman Ihdayhid, John Ramzy, Michael Michail & Adam Brown

  2. Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea

    Jin-Sin Koh & Habib Samady

  3. Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road, Suite F606, Atlanta, GA, 30322, USA

    Jin-Sin Koh, Arnav Kumar & Habib Samady

  4. Institute of Cardiovascular Science, University College London, London, UK

    Michael Michail

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  1. Abdul Rahman Ihdayhid
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Correspondence to Habib Samady.

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Conflict of Interest

Abdul Rahman Ihdayhid reports consulting fees from Boston Scientific.

Habib Samady reports grants and personal fees from Philips, grants from Abbott Vascular, and grants from Gilead; and he is a Co-Founder of COVANOS. In addition, Dr. Samady has a pending patent for Computational physiology related.

Jin-Sin Koh, John Ramzy, Arnav Kumar, Michael Michail, and Adam Brown declare that they have no conflict of interest.

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Ihdayhid, A.R., Koh, JS., Ramzy, J. et al. The Role of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Measurements in Patients with Acute Coronary Syndrome. Curr Cardiol Rep 21, 159 (2019). https://doi.org/10.1007/s11886-019-1233-6

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