Dr. Ganesh Manoharan
Management of multivessel disease, an area that generates much debate and heated exchange of views, can be challenging. Current guidelines suggest that these cases should be discussed and risk stratified (syntax score) by a multidisciplinary team / HEART team. There is an increasing awareness and acceptance, however, that there is a difference between ‘visual’ multivessel disease and ‘functional’ multivessel disease. This session focused on the use of fractional flow reserve (FFR) in this context: Dr Hamilos presented a good overview/summary of the studies to-date on the use of FFR in various clinical setting. Long term data from the DEFER, FAME and registry of left main disease were presented. The benefit of FFR guided strategy was maintained up to 5 year follow-up in the DEFER study and up to 2 year follow-up in the FAME study. Dr Muller followed on to describe the inaccuracies of using angiography / visual estimation to predict lesion severity of the left main. He showed data on the patency rates of grafts being affected if functionally non-significant lesions were intervened. The use of FFR in left main disease were explored in more detail, showing long term registry data to support the use of FFR in this setting. Dr Barbato very eloquently presented the clinical scenarios where FFR can be and should not be used in patients presenting with acute coronary syndromes. Assessment of a non-culprit lesion can safely be performed during the index procedure but not of the culprit artery. The importance of achieving maximum hyperaemia and the impact of myocardial stunning or infarct muscle on FFR were also discussed. Finally, Dr Trani presented on the role of FFR on diffuse disease. Data on a local study was presented, suggesting that the use of intracoronary bolus of adenosine is adequate in the majority of patients and the use of intravenous adenosine clears the borderline cases. Issues surrounding FFR in tandem lesions were also discussed. In summary, this was an excellent session, giving a thorough overview of the data, clinical importance and impact of FFR in clinical practice.
Fractional flow reserve is mandatory for the treatment of multivessel disease
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