Introduction: We present the different roles of fractional flow reserve and optical coherence tomography in guiding treatment in a patient with recurrent chest pain.
Case presentation: A 66-year-old Chinese woman presented to our department for the third time for her recurrent chest pain. Her physical examination was unremarkable; her previous two angiography examinations indicated that there was a stenosis of 50 to 70% in her proximal left anterior descending coronary artery. Optimal medical therapy was applied, but her symptoms did not disappear. Coronary angiography was conducted again after admission, accompanied by fractional flow reserve and optical coherence tomography. A lesion of 50 to 70% in her left anterior descending coronary artery was detected in an angiogram as before; her fractional flow reserve measure was a negative result of 0.88. However, a plaque rupture was found at the location of the lesion in the optical coherence tomography imaging. A stent was implanted in her left anterior descending coronary artery; she made no complaint of chest pain during follow-up of 1.5 years after her discharge.
Conclusions: Fractional flow reserve is considered the "gold standard" to detect ischemia-causing lesions and provide hemodynamic information of a stenosis. However, lack of structural information of a stenosis limits the application of fractional flow reserve and coronary pressure may lie sometimes. We should choose the best strategy for patients according to different examinations and patients' symptoms, never a single test.