by
Gus Iversen, Editor in Chief | March 31, 2026
Results from the FAST III trial indicate that an angiography-based approach to assessing coronary lesions may offer a comparable alternative to traditional pressure wire-guided methods during revascularization.
The multicenter, randomized, open-label study enrolled 2,235 patients across 37 hospitals in seven European countries. Investigators compared outcomes of percutaneous coronary intervention (PCI) guided by vessel fractional flow reserve (vFFR) with those guided by conventional fractional flow reserve (FFR). Findings were presented at the American College of Cardiology annual meeting and published in the New England Journal of Medicine.
The study met its noninferiority endpoint, showing similar clinical outcomes between the two approaches in patients with intermediate coronary artery stenosis. The vFFR method, calculated from two angiographic images using Pie Medical Imaging’s software, does not require a pressure wire or pharmacologically induced hyperemia.
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“The use of vFFR eliminates the need for guiding catheters, invasive coronary artery instrumentation and hyperemic agents with inherent risks and patient discomfort,” said Dr. Joost Daemen, chief investigator of FAST III and cardiologist at Erasmus University Medical Center in Rotterdam, Netherlands.
FFR is commonly used to determine whether coronary stenoses limit blood flow sufficiently to warrant intervention. The standard approach involves advancing a pressure wire into the coronary artery and administering agents such as adenosine, which can cause transient side effects including chest discomfort and shortness of breath.
By contrast, vFFR relies on angiographic imaging, potentially simplifying workflow and expanding access to physiologic assessment in centers that perform diagnostic angiography without invasive pressure measurements.
The trial was sponsored by the European Cardiovascular Research Institute and co-funded by Siemens Healthineers and Pie Medical Imaging. Cardialysis, based in Rotterdam, managed study execution.
While the findings may inform future guideline discussions, broader adoption will likely depend on integration into clinical practice and further real-world data on outcomes and cost implications.
