Fractional Flow Reserve: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object vascular::FRACTIONAL_FLOW_RESERVE_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara5168025d

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Fractional Flow Reserve: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara5168025d

Editorial note

• Last update: 2026-06-03 15:31:50

What is this paper about

Fractional flow reserve is no longer just a coronary pressure number—it is a decision framework that reshapes revascularization, deferral, imaging, plaque assessment, and vascular risk stratification across clinical settings. This full read maps 3,488 original studies, 615 key references, and more than 42.4 million observations to show where FFR is reliable, where it fails, and why physiology must increasingly be combined with plaque and microvascular context.

Human-verified editorial review Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.

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Abstract: To synthesize the structured evidence on fractional flow reserve (FFR), emphasizing its role in lesion assessment, revascularization guidance, deferral safety, prognostication, noninvasive and angiography-derived alternatives, and integration with plaque and microvascular evaluation. The review uses 615 references and builds its evidence map from 3488 original studies with 42464789 total participants/sample observations (topic-deduplicated ΣN). Across the mapped evidence, FFR emerges as a clinically actionable physiologic reference that reclassifies angiography-based decisions in roughly one-third to nearly one-half of patients and supports safer, more selective revascularization, with FFR-guided PCI reducing long-term events versus medical therapy alone (13.9% vs 27.0% at 5 years) and enabling generally safe deferral above the 0.80 threshold. However, the recurrent signal of residual risk in acute coronary syndromes, diabetes, chronic kidney disease, microvascular dysfunction, and vulnerable plaque indicates that a single hyperemic pressure cutoff is insufficient for comprehensive risk stratification. Angiography- and CT-derived FFR alternatives show promising diagnostic and workflow value but have not uniformly matched wire-based FFR for deferral outcomes. This supports a role for integrating FFR with plaque imaging and microvascular indices in routine practice, while future research should prioritize endpoint-powered trials defining when standard FFR thresholds require contextual personalization.

Keywords: Fractional flow reserve; Coronary artery disease; Coronary angiography; Intermediate coronary lesions; Percutaneous coronary intervention; Stable angina; Adenosine hyperemia; Instantaneous wave-free ratio; Coronary flow reserve; Virtual FFR

Review Stats

Final search date and database lock: 2026-05-25 23:05:58 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 5579
Downloaded Abstracts/Papers: 5579
Included original and non-original Abstracts/Papers (all): 4876
Included original Abstracts/Papers (Vote counting by direction of effect): 3488
Reference Index (links used in paper): 615
Total participants/sample observations (topic deduplicated ΣN): 42464789

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Reference Index (615)

[1] Benefits of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention. — https://doi.org/10.1016/j.jacasi.2022.05.001
[2] Fractional flow reserve versus intravascular ultrasound during percutaneous intervention. — https://doi.org/10.1097/ms9.0000000000002313
[3] Coronary fractional flow reserve. — https://doi.org/10.2214/ajr.14.13933
[4] Angiographic Fractional Flow Reserve: Easier, Potentially Faster, and Less Invasive But Is it Better? — https://doi.org/10.1016/j.jcin.2023.04.046
[5] Fractional Flow Reserve to Guide Coronary Artery Bypass Grafting. — https://doi.org/10.1016/j.jcin.2020.01.209
[6] Decoding fractional flow reserve/instantaneous wave-free ratio discordance: is flow the answer? — https://doi.org/10.1007/s12471-023-01822-y
[7] Brightening Your Vision With Fractional Flow Reserve and Intravascular Ultrasound. — https://doi.org/10.4070/kcj.2024.0209
[8] Is it Time to Revisit Fractional Flow Reserve Thresholds? — https://doi.org/10.36660/abc.20230363

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