![]() During the 25 subsequent years, several other studies have confirmed that FFR provides an invasive measure of relative stress flow by cardiac PET. Indeed, the second ever publication on FFR validated the metric for the first time in humans via relative flow reserve imaged using cardiac PET. While some countries like the United States have long had a payment criterion that demanded “objective evidence of myocardial ischemia”, other countries like Japan introduced specific wording to this effect only in April 2018 in response to the overwhelming accumulation of evidence.īut-often overlooked during the emergence of FFR-cardiac positron emission tomography (PET) with absolute blood flow quantification has shared an intimate connection. ![]() An excess of 2201 citations for the FAME study in 10 years and the elevation of FFR in the guidelines quantify the gradual but relentless transformation. Whereas the COURAGE trial from 2007 selected lesions using a classic, visual 70% diameter stenosis criterion-and failed to provide any benefit over medical therapy-the FAME trial from 2009 treated only lesions with a reduced fractional flow reserve (FFR) and demonstrated superior clinical outcomes. During the past decade, coronary revascularization has moved from anatomic-driven decisions to a physiology-based approach.
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