The prognostic value of residual coronary stenoses after functionally complete revascularisation

Fractional flow reserve (FFR) has become the gold standard for functional assessment of coronary artery stenosis. Studies have confirmed the superiority of FFR guided percutaneous coronary intervention (PCI) compared to angiography guided PCI. Due to the high cost of FFR, it is not economically viable for FFR to be incorporated into every routine invasive coronary angiography. As a result, visual estimation of diameter stenosis on invasive coronary angiography still remains the cornerstone for decision making regarding revascularisation treatment for patients. This is despite recent studies questioning the “visual functional mismatch” between diameter stenosis and FFR in 57% of patients with non-left main stenosis. In patients with multivessel disease, complete revascularisation leads to improved long term outcomes. However, some lesions classified as significant by angiography may not be functionally significant. Kobayashi and colleagues demonstrated that after functionally complete revascularization with FFR guidance, residual angiographic lesions that are not functionally significant do not reflect residual ischemia or predict a worse outcome, supporting functionally complete, rather than angiographically complete, revascularization.