Should we use invasive fractional flow reserve (FFR), imaging, or both to determine the significance of a “borderline” lesion?

Key Points Anatomy and physiology do not correlate well for the borderline stenosis. FFR (and NHPR) identify patients who will benefit more than those undergoing percutaneous coronary intervention (PCI) based on anatomy alone. For the borderline lesion in the SIHD patient, apply physiology for when to treat, and anatomy (imaging) for how to treat.