Role of Postintervention Fractional Flow Reserve to Improve Procedural and Clinical Outcomes

The value of fractional flow reserve (FFR) in determining the appropriateness of percutaneous coronary intervention (PCI) has been well established and incorporated into current guidelines and appropriate use criteria. However, the value of performing FFR after intervention is uncertain. This review provides the current evidence base highlighting the clinical and prognostic implications of post-PCI FFR. It provides evidence for improvement in post-PCI FFR with subsequent interventions (functional optimization) challenging the notion that FFR after angiographic optimization is fixed because of the underlying plaque burden. Multiple large observational studies and post hoc analyses of randomized trials have established that post-PCI FFR value is independently predictive of long-term outcomes (higher is better). The accumulated evidence suggests that post-PCI FFR be incorporated into routine practice in those patients having undergone pre-PCI FFR as part of clinical decision making.