{
  "abstract": "Background: Fractional flow reserve (FFR) is established to guide revascularization in stable coronary disease and non‐culprit lesions in acute coronary syndromes (ACS). However, real‐world adherence to FFR guidance across the spectrum of ACS presentations, including ambiguous culprit scenarios, remains incompletely characterized.\n\nAims: To evaluate the clinical impact of adherence to FFR guidance in ACS.\n\nMethods: From a multicenter prospective FFR registry, we analyzed 501 ACS patients who underwent FFR measurement: 222 with clear culprit lesions and 279 with ambiguous culprit lesions. Patients were classified as FFR‐concordant (all FFR ≤ 0.80 treated; all FFR > 0.80 deferred) or FFR‐discordant (≥ 1 FFR‐hemodynamic mismatch). The patient‐oriented composite endpoint (POCE) comprised all‐cause death, myocardial infarction, or any revascularization; the patient‐oriented FFR‐related composite endpoint (POFRC) comprised cardiac death or myocardial infarction or revascularization involving an FFR‐assessed vessel at 2 years.\n\nResults: Among 501 patients, 431 (86%) received FFR‐concordant management and 70 (14%) FFR‐discordant management. FFR discordance clustered in the gray zone (0.75–0.85), with 3.5‐fold higher prevalence compared with other FFR ranges. Over 2 years, FFR‐discordant management was associated with significantly higher POCE (Kaplan−Meier incidence 20.0% vs. 10.4%; propensity‐weighted hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.27–4.29, p = 0.009). The POFRC confirmed and strengthened this association (19.0% vs. 8.8%; propensity‐weighted HR 2.59, 95% CI 1.37–4.91, p = 0.004). The adverse impact of FFR discordance was consistent across clear culprit and ambiguous culprit subgroups (p for interaction = 0.52) and across types of ACS (p for interaction = 0.91).\n\nConclusions: In real‐world ACS management, adherence to FFR guidance is associated with superior clinical outcomes compared with FFR‐discordant decision‐making.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea",
    "Department of Internal Medicine Division of Cardiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of Korea",
    "Department of Internal Medicine Division of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Uijeongbu Republic of Korea",
    "Department of Internal Medicine Division of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea",
    "Department of Internal Medicine Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Eun Ho Choo",
      "orcid": "0000-0003-3166-3176"
    },
    {
      "affs": [
        1
      ],
      "name": "Ik Jun Choi",
      "orcid": "0000-0001-9996-2346"
    },
    {
      "affs": [
        2
      ],
      "name": "Sungmin Lim",
      "orcid": "0000-0003-4833-4440"
    },
    {
      "affs": [
        3
      ],
      "name": "Donggyu Moon"
    },
    {
      "affs": [
        4
      ],
      "name": "Dae‐Won Kim",
      "orcid": "0000-0002-2219-1835"
    },
    {
      "affs": [
        0
      ],
      "name": "Kiyuk Chang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b3tk81yrch0gx.bib",
  "cited_by": 0,
  "doi": "10.1002/ccd.70853",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13725188/",
  "id": "b3tk81yrch0gx",
  "issns": [
    "1522-1946",
    "1522-726X"
  ],
  "landing_url": "https://doi.org/10.1002/ccd.70853",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article ‐ Clinical Science"
    ],
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ]
  ],
  "openalex": "W7212284649",
  "pdf_url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ccd.70853",
  "pmcid": "PMC13725188",
  "pmid": "42723507",
  "published": "2026-09-11",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/b3tk81yrch0gx.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:23:38Z",
      "native_id": "PMC13725188",
      "source": "pmc",
      "url": "https://doi.org/10.1002/ccd.70853"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
    }
  ],
  "title": "Clinical Impact of Adherence to Fractional Flow Reserve Guidance in Acute Coronary Syndrome",
  "title_text": "Clinical Impact of Adherence to Fractional Flow Reserve Guidance in Acute Coronary Syndrome",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:31Z",
  "url": "https://research.draconitic.com/paper/b3tk81yrch0gx",
  "venue": "Catheterization and Cardiovascular Interventions",
  "versions": []
}