What About All the Recent "Negative" FFR Trials?

Nils P Johnson

doi:10.1016/j.ccl.2023.07.009

What About All the Recent "Negative" FFR Trials?

Cardiol Clin. 2024 Feb;42(1):31-39. doi: 10.1016/j.ccl.2023.07.009.

Author

Nils P Johnson¹

Affiliation

¹ Division of Cardiology, Department of Medicine, Weatherhead PET Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin Street, Room MSB 4.256, Houston, TX 77030, USA. Electronic address: Nils.Johnson@uth.tmc.edu.

PMID: 37949538
DOI: 10.1016/j.ccl.2023.07.009

Abstract

During the past 30 years, fractional flow reserve (FFR) has moved from animal models to class IA recommendations in guidelines. However, the FLOWER-MI, RIPCORD-2, FUTURE, and FAME 3 trials in 2021 were "negative"-has FFR exceeded its expiration date? We critically examine these randomized trials in order to draw insights not just about FFR but also about study design and interpretation. Are all randomized trials created equal? No, rather we must focus on discordant decisions between angiography and FFR and highlight clinical endpoints that can be improved by percutaneous coronary intervention instead of medical therapy.

Keywords: Coronary artery bypass grafting; Fractional flow reserve; Percutaneous coronary intervention; Randomized controlled trial.

Publication types

Review

MeSH terms

Coronary Angiography
Coronary Artery Disease* / therapy
Fractional Flow Reserve, Myocardial*
Humans
Percutaneous Coronary Intervention*
Treatment Outcome