The cooler is one of the key features of this particular card due to the fact that it keeps the GPU exceptionally cool, 61°C at full load, and that it does so in near silence. That good performance continues into power use where the Sapphire 6790 requires fewer watts than the competing GeForce model.
Looking specifically at gaming we have a card which AMD claim is perfect for gaming at 1080p and for the most part we would have to agree. In all but one of the games tested today the Sapphire 6790 was more than capable of gaming at that level, often with decent levels of anti-aliasing and anisotropic filtering too... and always at maximum detail. This includes games such as Crysis 2.
So that brings us to value and at £120/$150 the 6790 seems priced at an appropriate level. It performs below the 6850 and above the 5770, more often than not exceeding the GeForce 550 Ti too. The only issue in the current market is that currently models such as the Sapphire 5830 are priced exceptionally well and in many games it offers slightly better performance. That said the 6790 is a more future proof model thanks to the way it handles Tessellation and so using the Heaven benchmark as an example the 6790 is faster than the 5830. Can't be bad to have two such stong models in the £100-120 price range can it?
Summary
The Sapphire Radeon 6790 does what it sets out to do, offers better gaming performance and value than the GTX 550 Ti and does so while using less power and running at lower temperatures.