The Particulars: Treatment decisions for most patients with non-ST-segment elevation myocardial infarction (NSTEMI) are based on visual interpretation of a coronary angiogram. This subjective interpretation could lead to misdiagnosis and incorrect treatment. Fractional flow reserve (FFR) measurement assesses the physiological severity of a coronary blockage using a pressure-sensitive guidewire and could be an alternative to angiography.

Data Breakdown: For a study, researchers analyzed 350 patients with acute NSTEMI and angiography results showing at least one coronary artery for which FFR might have diagnostic value. Participants were randomized to receive care based on angiogram results or to undergo diagnostic FFR. Treatment plans were revised in 21.6% of patients randomized to FFR. Additionally, 22.7% of intervention patients avoided revascularization, compared with 13.2% of those with angiography-guided treatment. Revascularization-related myocardial infarction tended to be lower in the FFR group, and all major adverse cardiac events were similar in both groups.

Take Home Pearl: FFR appears to help more than one-fifth of NSTEMI patients avoid stents or surgery.