He arrived at my office clutching the outcomes of his coronary CT scan. His gaze went straight to the figures, his voice taut: “Doctor, my FFR is 0.86. Will I need a stent?”

This query is increasingly common. Coronary CT angiography with fractional flow reserve (FFR-CT) is swiftly becoming a standard instrument in cardiology. It provides us with noninvasive insight into the functional significance of a coronary lesion. In simple terms, it aids us in determining whether a narrowing is severe enough to hinder blood flow and potentially cause ischemia. However, for patients, the numbers induce anxiety. They observe a threshold, they notice decimals, and they seek clarity: stent or no stent? Traditionally, invasive FFR assessed in the cath lab directed those choices. An FFR <=0.80 has long been deemed hemodynamically significant. Yet now, with FFR-CT, patients come to the clinic already equipped with their “score.” When the number falls within the borderline range (think 0.82, 0.83, 0.86), the uncertainty causes genuine distress.

What the research indicates

Research has confirmed FFR-CT as a trustworthy diagnostic method, correlating effectively with invasive FFR. Crucially, values exceeding 0.80 are typically linked to no hemodynamically significant blockage. Patients in this category do not gain from stenting. Instead, they gain the most from medical management: statins, control of blood pressure, care for diabetes, cessation of smoking, diet, and exercise. The major trials that have shaped contemporary cardiology, COURAGE, ISCHEMIA, and FAME, continuously remind us that while stents alleviate symptoms, they do not enhance survival in stable coronary disease. It is the optimal medical therapy that influences long-term results. Thus, when a patient with an FFR-CT of 0.86 inquires about needing a stent, the response is clear: not based solely on this test.

Where this positions patients

However, clarity for the physician doesn’t always translate to clarity for the patient. Patients associate “plaque” with “blockage” and “blockage” with “heart attack.” They desire action, something to be remedied. Explaining that refraining from intervention is, in fact, the safer, evidence-based route can seem counterintuitive to them. This is where our responsibility as physicians goes beyond interpreting data. We must reassure, educate, and provide context. A stent isn’t a solution for atherosclerosis. It represents a treatment for symptoms when medical therapy falls short. Sometimes, the boldest decision is not to act but to prevent advancement through lifestyle changes and medication.

My guidance to patients

• Avoid chasing the number: An FFR-CT exceeding 0.80 indicates that your flow is intact. That’s positive news.
• Concentrate on risk factors: Cholesterol, blood pressure, blood sugar, weight, and smoking have far greater significance for your long-term prognosis than a single borderline FFR value.
• Take your medications earnestly: Statins, antihypertensives, and aspirin (when appropriate) are not “optional.” They are your primary defense.
• Pay attention to your symptoms: If chest pain continues despite treatment, then more evaluation and sometimes a stent may be necessary.

The patient with the 0.86 FFR-CT left feeling reassured. No stent. No cath lab. Just a clear strategy: optimize risk factors, take medications, and schedule a close follow-up.

Technology provides us with numbers, but medicine demands wisdom. As cardiologists, we must connect the research findings with our patients’ fears. Often, the best care we can provide is not the stent; it’s the conversation.

Monzur Morshed is a cardiologist. Kaysan Morshed is a medical student.