Reference lists of relevant studies were manually searched for additional studies. 6–8Ī systematic literature search was conducted in Embase, Medline, Cochrane Database of Systematic Reviews and Cochrane Central Registers of Controlled Trials through to 15 October 2017. Finally, the accuracy of FFR in the ACS population remains unclear. 1 5 Importantly, the safety of FFR-guided deferral of percutaneous coronary intervention (PCI) in patients with ACS remains unaddressed, particularly as the diagnostic threshold of 0.750.80 has not been specifically validated in this population. Indeed, an FFR-guided treatment strategy has not been found to improve patient prognosis compared with angiography alone in patients with NSTEACS ( online supplementary figure S2). While FFR-guided complete revascularisation significantly improves patient outcomes following culprit vessel primary PCI, 3 4 its use in the assessment and therefore management of culprit arteries has not been firmly established. The use of FFR in the setting of acute coronary syndrome (ACS), however, remains an area of uncertainty. An FFR-guided management approach results in better patient outcomes compared with angiography alone, 1 while deferral of revascularisation for lesions above the validated physiological threshold appears safe in this setting. The role of fractional flow reserve (FFR) in the assessment of coronary lesions of indeterminate severity is well-established for patients with stable angina (SA).
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