Since the publication of the FAME-1 study, the use of pressure wires to measure FFR increased from ~400 cases per year to ~1,000 cases per year in BC. However, in comparison with an annual non-emergent PCI volume of >6,000 cases per year, the use of FFR appears highly selective (1,058 out of 6,169, 17%, based on year 2011 statistics). In a series of 442 consecutive FFR cases done at the Vancouver General and St. Paul's Hospitals (year 2011 to 2012), the use of FFR identified non-ischemic lesions in 52%, and this resulted in a change in management decision in 68%. In addition, provincial data showed significant variation in the use of FFR among the 5 PCI capable hospitals in BC (from <5% to ~30%). Based on the recent European Society of Cardiology guidelines, the use of FFR to guide revascularization has a class 1a indication in multi-vessel disease, while the US guidelines (American College of Cardiology, ACC) has a class 2a recommendation for the use of FFR in evaluating coronary lesions of intermediate severity. It is possible that a highly selective approach to the use of FFR may lead to underuse, which in turn may lead to overuse of PCI, with increased cost, and adverse clinical outcome.