Fractional flow reserve (FFR) of intermediate coronary stenosis is a highly accurate, reproducible, and cost-effective modality with powerful prognostic value. Results of the FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) (1) and FAME-2 trials (2) have shown a significant reduction in major adverse cardiovascular events with FFR-guided coronary intervention in patients with stable coronary disease. More recent studies including the FAMOUS-NSTEMI (Fractional Flow Reserve Versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes) randomized trial, have demonstrated the utility of FFR in patients with acute coronary syndromes (ACS) (3). Despite the strong evidence base, FFR is still underutilized in the United States. A 1-year (2008 to 2009) analysis from the National Cardiovascular Data Registry showed that FFR evaluation was undertaken in only 6% of intermediate lesions (4). We examined U.S. trends of FFR utilization after publication of the pivotal FAME trial (2009).
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