FFR-guided strategy, for complete revascularization, has the potential to considerably decrease the number of unnecessary interventions during multivessel PCI and the number of subsequent revascularizations. Several pivotal studies have shown that FFR-guided coronary revascularization is a safe and effective in patients with single and multivessel CAD.

The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study demonstrated the significance of FFR in patients with multivessel coronary disease undergoing revascularization. FFR-guided PCI was associated with lower 1-year adverse events and reduced costs. The FAME 2 study compared FFR-guided PCI with medical therapy alone, and revealed FFR-guided PCI to improve the outcome. Patients without evidence of ischemia had favorable outcomes without PCI. The Compare-Acute trial compared FFR-guided, complete revascularization in the acute setting of primary PCI with infarct-related, coronary-artery-only revascularization in patients with STEMI. The study revealed that in patients with STEMI and multivessel disease who underwent primary PCI of an infarct-related artery, the addition of FFR-guided complete revascularization of non–infarct-related arteries in the acute setting led to a risk of a composite cardiovascular outcome that was lower than the risk among those who were treated for the infarct-related artery only.

The FIND study done in India revealed that FFR reduced CABG and number of stents. The study revealed that Indians with more severe form of CAD benefit from FFR-based management plan for intermediate lesions, both clinically and economically.