The role of coronary flow reserve (CFR) and fractional flow reserve (FFR) in acute coronary syndrome - systematic review.


  • TARIȚA Dumitru Spitalul NOVAMED
  • DANILA Tatiana IMSP Institutul de cardiologie
  • CIOBANU Lucia IMSP Institutul de cardiologie
  • POPOVICI Ion IMSP Institutul de cardiologie



Coronary flow reserve (CFR), Fractional flow reserve (FFR), Acute coronary Syndrome (ACS), NSTEMI Myocardial Infarction


The methods used to appreciate the degree of coronary stenosis such as CFR and FFR, come to complement the coronary angiography and help the interventional physician during PCI. Furthermore, CFR and FFR measured immediately after reperfusion, in patients with ACS, may act as a prognosis factor for myocardial infarction.Changes in coronary microcirculation in patients with ACS and NSTEMI correlate to the degree and extent of tissue lysis processes.So far, there are few data revealing the degree of microvascular bed injury and vasodilator capacity in patients with acute myocardial infarction. In this article, we will refer to some studies in the field.

Author Biographies

TARIȚA Dumitru, Spitalul NOVAMED

medic specialist în Cardiologie Intervențională și Chirurgie Cardiovasculară

DANILA Tatiana, IMSP Institutul de cardiologie

medic cardiolog, doctorand

CIOBANU Lucia, IMSP Institutul de cardiologie

doctor habilitat în știinte medicale, conf. cercetător

POPOVICI Ion, IMSP Institutul de cardiologie

profesor, doctor habilitat în Științe Medicale, Cardiolog Intervenționist


Brian P. Griffin, Thomas D. Callahan, Venu Menon et al., Manual of Cardiovascular Medicine 4th edition, 2012

Mukherjee Debabrata, Anthony A. Bavry, Interventional Cardiology Essential Clinician’s Guide, Oxford American Cardiology Library, 2010

Matthijs Bax, Robbert J de Winter, Carl E Schotborgh, Karel T Koch, Martijn Meuwissen, Michiel Voskuil, Rob Adams, Karla J J Mulder, Jan G P Tijssen, Jan J Piek, Shortand long-term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction, J Am Coll Cardiol. 2004;18;43(4):534-41

Harald Lethen, Hans P Tries, Stefan Kersting , Heinz Lambertz, Validation of noninvasive assessment of coronary flow velocity reserve in the right coronary artery: A comparison of transthoracic echocardiographic results with intracoronary Doppler flow wire measurements European Heart Journal, 2003;24:17

Jamie Layland, MBChB, David Carrick, MBChB, Margaret McEntegart, MBChB, PhD, et al., Vasodilatory Capacity of the Coronary Microcirculation is Preserved in Selected Patients with Non–ST-Segment–Elevation Myocardial Infarction, Circulation: Cardiovascular Interventions.2013;6:3

A. Prasad, B. J. Gersh, Management of microvascular dysfunction and reperfusion injury, Heart. 2005;91:1530–1532

Murat Sezer, Berrin Umman, Irem Okcular, Yilmaz Nisanci, Sabahattin Umman, J Interv Cardiol. 2007;20(5):340-50

R. Montisci, L. Chen, M. Ruscazio, P. Colonna, C. Cadeddu, C. Caiati, M. Montisci, L. Meloni, S. Iliceto, Non-invasive coronary flow reserve is correlated with microvascular integrity and myocardial viability after primary angioplasty in acute myocardial infarction. Heart. 2006; 92(8):1113-8

Francesco Pizzuto 1, Paolo Voci, Enrica Mariano, Paolo Emilio Puddu, Patrizia Spedicato, Francesco Romeo, Coronary flow reserve of the angiographically normal left anterior descending coronary artery in patients with remote coronary artery disease, Am J Cardiol. 2004;1;94(5):577-82

Takefumi Takahashi 1, Yoshikazu Hiasa, Yoshikazu Ohara, Shin-Ichiro Miyazaki, Riyo Ogura, Hitoshi Miyajima, Ken-Ichiro Yuba, Naoki Suzuki, Shinobu Hosokawa, Koichi Kishi, Ryuji Ohtani, Usefulness of coronary flow reserve immediately after primary coronary angioplasty for acute myocardial infarction in predicting long-term adverse cardiac events. Am J Cardiol. 2007;100(5):806-11;

John-Ross D. Clarke, Randol Kennedy, Freddy Duarte Lau, Gilead I. Lancaster and Stuart W. Zarich, Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance. J. Clin. Med., 2020; 9:86.

Ozan M. Demir, Haseeb Rahman, Tim P. van de Hoef, Javier Escaned, Jan J. Piek, Sven Plein, Divaka Perera, Invasive and non-invasive assessment of ischaemia in chronic coronary syndromes: translating pathophysiology to clinical practice, European Heart Journal. 2022;43, 105–117





Research Article