Abstract
The concept of functional revascularization has been broadly accepted. Although the best clinical evidence has been provided in patients with chronic coronary syndromes, recent data strongly advocate its use also in patients with acute coronary syndromes.
Invasive pressure-derived indexes: hyperemic FFRmyo (myocardial fractional flow reserve) and resting iFR (instantaneous free ratio) or others require an interventional procedure by wiring the diseased vessel. Values of FFRmyo <= 0.80 and of iFR <= 0.89 are suggestive of functionally significant coronary disease mostly indicated for revascularization.
Moreover there are several non-invasive functional tests that can be used in clinical practice: perfusion scintigraphy, cardiovascular magnetic resonance and positron emission tomography, and the recently introducer FFRCT or quantitative flow ratio (QFR). In routine practice, the concept of functional revascularization avoids unnecessary coronary interventions and, in the case of functionally non-significant disease/stenoses, the patients may be treated conservatively with a very good prognosis.
Currently, the "functionally complete revascularization", instead of ananatomical one, should become our new target of treatment.