Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions

Adequate patient selection for percutaneous coronary intervention is of the greatest importance in order to minimize early and late complications. Therefore, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery disease, in particular in multivessel disease and those with intermediate lesions (40–70% diameter stenosis on angiography). The use of sensor-equipped guidewires for the assessment of functional coronary lesion severity has become extensive in the cardiac catheterization laboratory. The hemodynamic indices derived from intracoronary pressure or flow measurements, fractional flow reserve and coronary flow reserve, show a high agreement with noninvasive stress testing. Furthermore, deferral of percutaneous coronary intervention for hemodynamically nonsignificant lesions is associated with a low major adverse cardiac event rate. However, since these indices are based on either intracoronary pressure or flow, they do not investigate the hemodynami...