The future of angiography: Estimates of FFR pre‐ and post‐PCI

Functional evaluation of coronary artery stenoses using fractional flow reserve (FFR) has been established as the gold standard for evaluation of ischemia given its relation to clinical outcomes. However, with the need for hyperemic agents, wiring of the vessel, and increased procedural time FFR has not been universally adopted despite guideline recommendations. Although some of these factors are addressed with non‐hyperemic pressure derived ratios (NHPR), angiographic estimators of coronary physiology would eliminate the risk, expense, and time of placing a pressure wire in the vessel. Quantitative flow reserve ([QFR], Medis, Leiden, The Netherlands) predicts FFR from a three‐dimensional angiographic reconstruction of a target vessel. QFR has excellent diagnostic accuracy compared to invasive FFR and improves clinical outcomes when guiding PCI. QFR also provides a complete functional assessment of each of the three coronary arteries, which allows for the estimation of residual