Patients with Chronic stable angina and unstable angina also present a dilemma for further management based on results of coronary angiography alone. Estimation of Fractional flow reserve (FFR) allows to identify ischemia producing lesions in coronary tree. It has been proved beyond doubt that interventions for the lesions causing ischemia improves morbidity and mortality.

1. How I approach the patient with
angina
Dr. S K Agarwal
MD, DM, FACC, CBCCT
Consultant Interventional Cardiologist
Rashid Hospital
Dubai

2. FFR and MVD
Detection vs. Localization of ischemia
Test Spatial resolution
Exercise ECG Patient level
Stress Echo Myocardial territory
Stress MRI Myocardial territory
Myocardial
perfusion imaging
Myocardial territory
FFR Cm (mm)

3. FFR and MVD
Detection and Localization of ischemia
Vessel related ischemia
FFR: “Myocardial Perfusion Imaging available at tip of wire”

4. Clinical data
• 35 yrs. male , DM 3yrs , Dyslipidemic , IHD ( AWMI in
2015, rescue PCI with 1 DES in LAD ), smoker and
occasionally alcoholic , on regular medication
• presented to ER with typical angina.
• BP: 140/89, PR: 86, wt. 56kg
• ECG: No dynamic ECG changes
• Echo: Moderately impaired LV systolic Fx. EF 40 %
• Normal Cr, electrolytes, negative Trop T, A1c 6.8
28/7/2017 7/12/2016 22/10/2015
Chol 134 122 323
HDL 32 34 37
LDL 79 72 250
Trig 232 131 370

7. CAG
Where is the significant lesion?

8. CAG
Where is the significant lesion?
1) LAD
2) OM
3) Both or none

10. FFR of OM

11. PCI to OM

12. Post PCI FFR

13. FFR of LAD

14. Post PCI to LAD

15. Post PCI FFR
Cause of +ve FFR post PCI
Diffuse distal disease

16. Appropriateness criteria of doing PCI in DVD

17. FFR in UA & N STEMI
Experience from FAME
J Am Coll Cardiol Intv 2011;4: 1183
Stable vs. unstable
Same benefit in patients of stable / unstable angina

19. FFR is the new lens for
occulo-stenotic reflex

20. Look beyond angiographic
anatomy
• Thank you