Long-term Effects of Full-Cycle Ratio Assessment and the Decision to Delay Revascularization
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By
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Stephan Nienaber
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Jakob Wind
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Philipp Lake
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Victor Mauri
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M. Adam
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Karl Finke
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Henning Guthoff
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Stephan Baldus
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Marcel Halbach
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Hendrik Wienemann
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July 7, 2026
Clinical Scorecard: Long-term Effects of Full-Cycle Ratio Assessment and the Decision to Delay Revascularization
At a Glance
| Category | Detail |
|---|
| Condition | Coronary artery disease (CAD) |
| Key Mechanisms | Assessment of coronary stenosis using resting full-cycle ratio (RFR) and non-hyperemic pressure ratios (NHPR) |
| Target Population | Patients with angiographically intermediate coronary artery disease |
| Care Setting | Tertiary heart center |
Key Highlights
- CAD accounts for 35-40% of cardiovascular-related deaths in the EU and US.
- RFR assessment allows deferral of revascularization in non-ischemic cases.
- RFR ≤ 0.89 indicates myocardial ischemia; RFR > 0.89 supports deferral of intervention.
- Long-term outcomes of RFR assessment show low incidence of major adverse cardiac events (MACE).
- Current guidelines endorse FFR, but RFR is emerging as a viable alternative.
Guideline-Based Recommendations
Diagnosis
- Use of RFR for assessing functional significance of coronary stenoses.
Management
- Deferral of revascularization based on RFR values.
Monitoring & Follow-up
- Follow-up on MACE incidence at 2 years post-assessment.
Risks
- Potential for misclassification of ischemia in hemodynamically unstable patients.
Patient & Prescribing Data
773 patients with angiographically intermediate CAD
RFR measurement is standard for assessing coronary stenoses; deferral based on RFR values is clinically supported.
Clinical Best Practices
- Adhere to predefined RFR cutoff values during assessments.
- Conduct assessments in accordance with current guidelines and protocols.
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