Interventional cardiology without imaging: the concept of FFR

Coronary lesions descriptive anatomy always failed to predict cardiac events. Only ischemia has been shown to predict survival ischemic prognosis. Pressure catheter is a simple tool which allows mesasurement of fractional flow reserve (FFR) defined as the ratio between coronary pressure distal to lesion and aortic pressure. The measurement has to be done during maximal hyperaemia induced by venous or intracoronary infusion of papaverine or adenosine. A threshold of 0.80 has been validated values less than which indicate that the lesion is functionally significant and has to be revascularised. Numerous multicentric and scientifically rigorous studies have validated this concept in intermediate lesions, multivessel disease and post-infarctus which confirm the unique and universal impact of this lesion functional evaluation tool and which is unfortunately under used and under diffused in France.