Aim. To determine the role of intravascular methods in “expert” diagnosis of coronary artery disease. Material and methods. The study included 100 «expert» patients. All patients were divided into two groups after coronary angiography (CAG). Group I consisted of patients with «unchanged» coronary arteries (n=30) and Group II — with borderline lesion of coronary arteries (n=70). All patients underwent measurement of fractional flow reserve (FFR) in the arteries with the diameter over 2.5 mm. According to these data group II was conditionally divided into two subgroups: IIa — with a positive FFR value (≤0,8) and IIb — with a negative FFR value. All patients in IIa subgroup underwent coronary stenting under ultrasonic intravascular (IVUS) control. In subgroup IIb IVUS of coronary arteries was additionally performed after FFR measurement. Stenting was performed if unstable plaques were revealed and these patients were automatically moved into IIa subgroup. Results. FFR measurement was performed in 262 arteries: 62 arteries in group I and 200 arteries in group II. In group I all patients had negative FFR value (≥0.8). All patients in IIa subgroup underwent coronary stenting with drug-eluting stents. IVUS revealed unstable plaques in 5.3% of patients of subgroup IIb and they were transferred into IIa subgroup for elective PCI. In-hospital cardiovascular complications of diagnostic and therapeutic procedures were not observed. Survival was 100%. Long-term results were followed in all patients within 12—14 months (mean follow-up was 13.1±0.5 months). Major cardiac events and readmissions free survival was not significantly different in both groups (100 and 94.7%, respectively; p>0.05). Significant differences were also absent in subgroups IIa and IIb (96.9 and 94.7%, respectively; p>0.05). Conclusion. Negative FFR and stable plaque according to IVUS may be considered as a key criterion in earning capacity examination in railway workers. Algorithm of «expert» examination of patients with angiographically unchanged coronary arteries may be completed by coronary angiography while FFR measurement in arteries with borderline lesion combined with plaque morphology can reliably judge the diagnosis of coronary artery disease.