How to manage an asymptomatic 45 year old man with 90 % mid LAD lesion , with FFR .9 who is stress test positive at 9 Mets ?
Six cardiologists and six responses . . . and the elusive seventh sense
- FFR is most scientific test to assess physiology of coronary stenosis . I will go with that and put this patient under medical management.
- I agree with FFR, still the patient has no symptoms , but why the hell is EST + ve ? I am confused .
- I would definitely stent the lesion irrespective of the symptoms .
- I would order a stress thallium . I do not believe in FFR
- The data provided is insufficient. I would like to this patient in my clinic , and if necessary may order a fresh CAG.
- For a 90 % LAD lesion FFR should not have been done in the first place .That is the root of the confusion. He should have received a stent long back .
Final message
FFR is a terrible concept for two reasons . One , it never bothers about flow across a lesion. It simply relies upon pressure drop. we all know there is an intricate relationship between pressure and flow . Simple pressure drop can never be expected to translate into incremental flow in biological systems .The second major limitation is it ignores the morphology of the lesion . We know an eccentric soft lesion with a good distal FFR is live coronary explosive .
Dr.S.Venkatesan MD 