Abstract 472: Fractional Flow Reserve (FFR): FAR FROM REALITY
Fractional Flow Reserve (FFR) is the ratio of maximal blood flow in a stenotic artery to normal maximal flow. It is the “gold standard” technique used in diagnostic angiography to determine whether percutaneous intervention is needed in a moderate coronary stenosis (estimated 50-70% lesion). An FFR less than 0.8 may be falsely reassuring in a patient with unstable plaque who may be actively forming and dissolving clot.
This is a case of a 36 year old gentleman, with no significant past medical history, who presented to another local hospital with complaints of episodic chest pain that was located in the sub-sternal region and radiated to his left upper extremity. He was found to be mildly hypertensive, with elevated cardiac markers and with no EKG findings. On cardiac catheterization the patient was found to have a 50% lesion of left anterior descending artery and an FFR measurement of 0.93-0.91, therefore the lesion was not stented. The patient was subsequently discharged home. Two months later the patient presented to the hospital with crushing chest pain, and found to be having a ST elevation myocardial infarction. On repeat cardiac catheterization, the patient was found to have a 99% lesion of his left anterior descending coronary artery requiring placement of a drug eluting stent.
Cardiac catheterization is a life saving diagnostic and interventional modality for many patients with coronary artery disease. Fractional Flow Reserve is a new diagnostic tool used to guide management of coronary lesions with intermediate stenosis. It does not, however, take into account the pathophysiology of the lesion itself, for example a stable versus an unstable plaque. As in this case, a non flow-limiting lesion can still be unstable and plaque rupture can create a life-threatening myocardial event. With the development of intravascular ultrasound and optical computed tomography, the ‘gold standard’ seal of FFR will require reevaluation in regards to diagnostic modalities.
- © 2013 by American Heart Association, Inc.