A 76-year-old diabetic woman with a history of surgical revascularization in 1997 (left internal mammary artery [LIMA] on left anterior descending) was referred twice afterwards (June 2001 and February 2008) for stable angina. No stress test was available. In part of the invasive evaluations, an intermediate lesion at the proximal part of the right coronary artery (RCA) was routinely measured by fractional flow reserve (FFR) and proved functionally non-significant. The LIMA was checked and remained perfect and the ischaemia was allocated on both occasions to a minor marginal branch. Based upon the FFR value above 0.75, the clinical prognosis was considered excellent for the RCA and for the patient. Medical therapy was implemented and no revascularization was attempted on the RCA. Moreover, FFR values on the RCA were roughly similar on both occasions, indicating stability.
FFR is a valuable online clinical tool in the catheterization laboratory that provides accurate functional data for a given coronary stenosis. An FFR value greater than 0.75 or 0.80 allows postponement of revascularization in cases of either single- or multivessel disease. In the case of single-vessel disease, a 5-year clinical follow-up reinforces this postponement strategy. Our example of an intermediate RCA lesion reassessed after 79 months provides support for this functional approach ( Fig. 1 ).
