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Role of fractional flow reserve in the evaluation and management of patients with acute coronary syndrome

Hakeem, Abdula,b; Almomani, Ahmeda,b; Uretsky, Barry F.a,b

doi: 10.1097/HCO.0000000000000448
ISCHEMIC HEART DISEASE: Edited by Peter H. Stone

Purpose of review The aim of this review is to appraise the clinical and prognostic value and pitfalls of FFR across different spectra of ACS presentations and lesion subsets.

Recent findings Preponderance of evidence on this subject is from observational nonrandomized studies with conflicting results and short-term outcomes. Multiple recent studies evaluating the role of FFR-based deferral in non-STE ACS from a potentially culprit lesion have demonstrated poor long-term prognosis as related to future risk of target vessel failure (myocardial infarction/revascularization). The prognostic power of nonischemic FFR seems favorable in clear nonculprit ACS lesions.

Summary Fractional flow reserve evaluation can be helpful in clinical decision-making for certain subsets of ACS patients and lesions. Definite ACS-producing lesions should not be evaluated using FFR due to altered pathophysiology and distinct mechanisms underlying the disease process. In uncertain culprit lesions, FFR may be useful with complementary intracoronary imaging.

aCentral Arkansas VA Health System

bUniversity of Arkansas for Medical Sciences, Little Rock, Arizona, USA

Correspondence to Abdul Hakeem, MD, FACC, FSCAI, FASE, Assistant Professor of Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, 72205-7199, USA. Tel: +1 608 695 3048; fax: +1 501 686 6439; e-mail:

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