Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

FDA‑approved noninvasive FFR (FFRct) is reasonable for intermediate‑risk patients (per 2021 chest pain guideline) with acute or stable chest pain when CCTA demonstrates 40–90% stenosis in a proximal or mid coronary artery, and for patients with persistent ischemic symptoms despite maximally tolerated medical therapy. FFRct must be performed only after a completed and interpreted CCTA (images sent for post‑processing) and is contraindicated or not reasonable in multiple scenarios including prior coronary stents or grafts, prosthetic valves, recent MI (≤30 days), suspected acute coronary syndrome, heart transplant status, presence of pacemaker/ICD leads, very high‑grade (>90%) or nonobstructive (<40%) stenoses, or when post‑processing turnaround would delay urgent care.

"Intermediate-risk patients (per 2021 AHA/ACC chest pain guideline) with acute or stable chest pain, no prior known coronary artery stenosis, and CCTA demonstrating 40–90% stenosis in a proximal or ..."