FFR-gesteuerte Revaskularisation – wann indiziert, wann überflüssig?

Abstract

An invasive measurement of the fractional flow reserve (FFR) allows the valuation of the individual risk for ischemic events in patients with coronary artery disease. Therefore, FFR has become a valuable tool to guide coronary revascularisations. The cut-off value ≤ 0.80 has been validated in many different subsets of patients. However, FFR values describe a risk continuum with an inverse correlation between FFR value and the risk of events. So FFR should always be interpreted regarding the patient’s clinical context, especially in patients with a high risk for rapid disease progression. As such, patients with diabetes mellitus and deferred revascularisation based on FFR > 0.80 had worse clinical outcomes compared to patients without diabetes. In addition, FFR shows methodical deficiencies concerning the quantification of serial stenoses as well as the valuation of residual ischemia of the culprit vessel early after myocardial infarction. This article highlights both the strengths and the pitfalls in the use and interpretation of FFR.

Die invasive Messung der fraktionellen Flussreserve (FFR) bietet die Möglichkeit, das individuelle Risiko für ischämische Ereignisse bei koronarer Herzkrankheit einzuschätzen. Viele Faktoren, die eine Progression der Atherosklerose begünstigen, sind dabei in die Auswertung einzubeziehen. Der Beitrag beleuchtet die Wertigkeit der FFR im klinischen Alltag sowie Indikationen, Risiken und Alternativen der FFR-gesteuerten Revaskularisation.

Schlüsselwörter

Fraktionelle Flussreserve - koronare Herzkrankheit - Myokardischämie - kardiovaskuläres Risiko - Diabetes mellitus

Key words

fractional flow reserve - coronary artery disease - myocardial ischemia - cardiovascular risk - diabetes mellitus

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