Yesterday at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) meeting, William Fearon (Stanford, USA) reported that fractional flow reserve (FFR) derived from a coronary angiogram (FFRangio, CathWorks) has very high sensitivity, specificity and diagnostic accuracy. He added that the system may be an easier and potentially faster approach to physiological assessment of the overall coronary angiogram.
Fearon noted that the use of FFR to guide treatment decisions is known to improve outcomes and has been incorporated in multiple guidelines, but stated “FFR utilisation, however, remains lower than expected because of a number of potential issues including the extra time it takes, wire handling characteristics, pressure wire drift, the need for hyperaemia, and the expense.” Therefore, a system such as FFRangio that can calculate FFR without the need for a pressure wire or hyperaemic agent may increase the uptake of FFR. The aim of FAST FFR was to compare the accuracy of onsite FFRangio with that of the conventional FFR.
In the study, 301 patients (319 vessels) with stable angina, unstable angina, or non-ST-segment elevated acute coronary syndromes underwent FFR and, using the patients’ angiogram results, FFRangio was simultaneously calculated. According to the results of the study, the diagnostic accuracy of FFRangio was 92% overall and remained high when only FFR values between 0.75 and 0.85 (87%) were considered. Furthermore, FFRangio values correlated well with FFR measurements (r=0.80, p<0.001).
Fearon concluded: “FFRangio may provide an easier and potentially faster method for performing physiology guided assessment of the overall coronary angiogram with similar accuracy to the reference standard, coronary pressure wire-based FFR,” adding that this may translate into “a greater percentage of patients undergoing physiologic guidance for revascularisation decisions and ultimately improve long-term outcomes”.