What are the limitations of the FFR (Fractional Flow Reserve)?

While the FFR (Fractional Flow Reserve) is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the FFR (Fractional Flow Reserve) to ensure safe bedside use and optimal diagnostic accuracy.

How does the FFR (Fractional Flow Reserve) compare to other Cardiovascular scores?

The FFR (Fractional Flow Reserve) is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the FFR (Fractional Flow Reserve) free to use?

Yes. OpiCalc provides the FFR (Fractional Flow Reserve) completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Functional assessment of coronary lesion severity during angiography
Decision-making: proceed with PCI vs. defer in intermediate stenosis
Multivessel disease triage (defer non-culprit lesions if FFR >0.80)
Guidance for staged revascularization strategy
≥50% but <90% angiographic stenosis requiring physiologic assessment

Key Points

FFR 0.75–0.80: borderline lesions benefit from serial assessment or iFR
FFR-guided PCI reduces MACE vs. angiography-only guided strategy
ESC/AHA recommend FFR for intermediate coronary lesions
Requires adenosine hyperaemia or equivalent stress; adenosine-free alternatives (iFR, RFR) emerging

CLINICAL INSIGHT

How it Works

Formula

Interpretation

FFR Value	Clinical Significance	Recommendation
≥0.80	Not ischaemic	Defer PCI; medical therapy
0.75–0.80	Borderline	Consider serial or iFR
<0.75	Ischaemic	PCI recommended
<0.50	Severe ischaemia	PCI strongly indicated

CLINICAL INSIGHT

Practical Pearls

Technical Pearls

Adenosine dose: 140–180 µg/kg/min IV (preferred); or 12–18 µg IC per vessel
Ensure true hyperaemia by observing ≥50% HR increase or equalization of distal/aortic pressures
Avoid nitroglycerin interference; check baseline Pd/Pa ratio pre-hyperaemia
Serial stenosis: pullback pressure tracing identifies contribution of each lesion

Clinical Gotchas

Microvascular dysfunction (diabetes, HFpEF) → falsely low FFR despite epicardial disease
Tandem lesions: FFR measures combined effect; difficult to attribute ischaemia to single lesion
Left main stenosis: FFR may underestimate true ischaemic burden
Chronic total occlusions: FFR not reliable for viability assessment

CLINICAL INSIGHT

Next Steps

FFR ≥0.80 (Not Ischaemic)

Defer PCI; medical therapy optimisation
Serial angiography at 6–12 months if high-risk features
Repeat FFR if anatomy changes or symptoms worsen
Culprit lesion PCI still appropriate if acute presentation

FFR 0.75–0.80 (Borderline)

Consider iFR (rest pressure ratio index) for confirmation
Conservative management if stable chronic CAD
Stress testing to correlate with objective ischaemia
Close follow-up; repeat FFR if lesion progression suspected

FFR <0.75 (Ischaemic)

PCI with modern stent (DES) recommended
Dual antiplatelet therapy ≥12 months (standard)
Serial follow-up catheterism if DAPT not tolerated
Consider multivessel FFR-guided revascularisation strategy

Complementary Calculators

CLINICAL INSIGHT

Evidence Base

Landmark Trials

CLINICAL INSIGHT

Clinical Reference Hub

When to Use

When to Use

Key Points

How it Works

Formula

Interpretation

Practical Pearls

Technical Pearls

Clinical Gotchas

Next Steps

FFR ≥0.80 (Not Ischaemic)

FFR 0.75–0.80 (Borderline)

FFR <0.75 (Ischaemic)

Complementary Calculators

Evidence Base

Landmark Trials

Background

Development

FFR (Fractional Flow Reserve)

Clinical Reference Hub

When to Use

When to Use

Key Points

How it Works

Formula

Interpretation

Practical Pearls

Technical Pearls

Clinical Gotchas

Next Steps

FFR ≥0.80 (Not Ischaemic)

FFR 0.75–0.80 (Borderline)

FFR <0.75 (Ischaemic)

Complementary Calculators

Evidence Base

Landmark Trials

Background

Development

FFR (Fractional Flow Reserve)

Clinical Evidence and Methodology

Clinical Reference Hub

When to Use

When to Use

Key Points

How it Works

Formula

Interpretation

Practical Pearls

Technical Pearls

Clinical Gotchas

Next Steps

FFR ≥0.80 (Not Ischaemic)

FFR 0.75–0.80 (Borderline)

FFR <0.75 (Ischaemic)

Complementary Calculators

Evidence Base

Landmark Trials

Background

Development

FFR (Fractional Flow Reserve)

Clinical Evidence and Methodology

Clinical Reference Hub

When to Use

When to Use

Key Points

How it Works

Formula

Interpretation

Practical Pearls

Technical Pearls

Clinical Gotchas

Next Steps

FFR ≥0.80 (Not Ischaemic)

FFR 0.75–0.80 (Borderline)

FFR <0.75 (Ischaemic)

Complementary Calculators

Evidence Base

Landmark Trials

Background

Development

FFR (Fractional Flow Reserve)