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Angiography-Based Physiology to Guide Coronary Revascularization.

Joost Daemen1, Jari A van der Eijk1, Marco Barbierato2

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PubMed
Summary
This summary is machine-generated.

Vessel fractional flow reserve (vFFR) guided revascularization is as effective as traditional pressure wire-based fractional flow reserve (FFR) for intermediate coronary lesions. This study shows noninferiority in major adverse events at one year, supporting vFFR as a viable alternative.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Current guidelines advocate physiological assessment for intermediate coronary lesions.
  • Limited data exist on vessel fractional flow reserve (vFFR) compared to pressure wire-based fractional flow reserve (FFR).
  • vFFR is derived from 3D-quantitative coronary angiography, avoiding pressure wires and hyperemic agents.

Purpose of the Study:

  • To compare the efficacy and safety of vFFR-guided versus FFR-guided revascularization.
  • To establish noninferiority of vFFR-guided revascularization.

Main Methods:

  • An international, open-label, randomized noninferiority trial (FAST III) involving 37 European sites.
  • 1116 patients in the vFFR group and 1095 in the FFR group with intermediate coronary lesions (30-80% stenosis).
  • Primary endpoint: composite of death, myocardial infarction, or revascularization at 1 year; noninferiority margin of 3.0 percentage points.

Main Results:

  • The primary endpoint occurred in 7.5% of patients in both the vFFR and FFR groups at 1 year (risk difference -0.02 percentage points).
  • Noninferiority was demonstrated (P=0.004).
  • Incidence of serious adverse events was similar between groups.

Conclusions:

  • vFFR-guided revascularization is noninferior to FFR-guided revascularization for intermediate coronary lesions.
  • vFFR offers a comparable alternative to FFR, potentially simplifying the procedure.
  • The findings support the use of vFFR in clinical practice for guiding revascularization decisions.