Routine Fractional Flow Reserve Combined to Diagnostic Coronary Angiography as a One-Stop Procedure: Episode 3.

R3F (Registre Français de la FFR) was the first study to investigate and demonstrate the clinical relevance of a new diagnostic concept based on the routine performance of fractional flow reserve (FFR) at the time of diagnostic angiography in patients suspected of coronary artery disease to define the optimal and individualized therapeutic option. The RIPCORD (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain) study, published a few months later, investigated the same idea and provided additional weight to the concept. It also gave us the opportunity to discuss several aspects of the concept and to further elaborate on its benefits. In short, this new diagnostic concept proposes to combine diagnostic angiography and FFR as a single one-stop procedure and intend to make it the ultimate tool for clinical decision making in patients suspected of coronary artery disease. The key benefit of such an approach is to allow to discharge the patient from the catheterization laboratory with a clear, detailed, and definitive therapeutic plan. This is of major importance at a time where the appropriateness of therapeutic decision is more than ever the ultimate goal of patients’ care and in a context where noninvasive tests have been shown to be often insufficient. Indeed as demonstrated many times, only 50% of patients are referred to coronary angiography with a noninvasive ischemic test performed before, and when they have been performed, their add-on diagnostic value—on top of a careful medical examination and history—has been challenged.