RT Journal
A1 Lin GA, Malenka DJ, Redberg RF
T1 DOcumenting ischemia prior to elective percutaneous coronary intervention—reply
JF JAMA
JO JAMA
YR 2009
FD March 11
VO 301
IS 10
SP 1018
OP 1019
DO 10.1001/jama.2009.259
UL http://dx.doi.org/10.1001/jama.2009.259
AB 
However, it is difficult to argue in favor of an approach that requires a diagnostic cardiac catheterization for patients who might not have needed one had they had a negative noninvasive test. Furthermore, FFR is an invasive procedure that carries small but significant additional risks beyond those associated with diagnostic coronary angiography, and the technology is available only in a minority of US catheterization laboratories. Finally, noninvasive testing with selective cardiac catheterization has been shown to be more cost-effective than routine cardiac catheterization for patients with stable coronary artery disease,2 so there are likely few situations where routine cardiac catheterization plus FFR would be more cost-effective than a strategy of initial stress testing.