Coronary interventions

Vessel fractional flow reserve (vFFR) for the assessment of stenosis severity: the FAST II study

EuroIntervention 2022;17:1498-1505. DOI: 10.4244/EIJ-D-21-00471

Kaneshka Masdjedi
Kaneshka Masdjedi1, MD, PhD; Nobuhiro Tanaka2, MD, PhD; Eric Van Belle3, MD, PhD; Sina Porouchani3, MD; Axel Linke4,5, MD, PhD; Felix J. Woitek4, MD, PhD; Antonio L. Bartorelli6, MD, PhD; Ziad A. Ali7,8, MD, DPhil; Wijnand K. den Dekker1, MD, PhD; Jeroen Wilschut1, MD; Roberto Diletti1, MD, PhD; Felix Zijlstra1, MD, PhD; Eric Boersma1, MD, PhD; Nicolas M. Van Mieghem1, MD, PhD; Ernest Spitzer9, MD, PhD; Joost Daemen1, MD, PhD
1. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; 2. Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan; 3. Department of Cardiology, Institut Cœur Poumon, CHU Lille, Lille, France and Department of Interventional Cardiology for Coronary Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France; 4. Technische Universität Dresden, University Clinic, Department of Internal Medicine/Cardiology, Dresden, Germany; 5. Dresden Cardiovascular Research Institute and Core Laboratories, Dresden, Germany; 6. Department of Cardiology, Centro Cardiologico Monzino, Milan, Italy; 7. Division of Cardiology, Columbia University, New York, NY, USA; 8. DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, NY, USA; 9. Cardialysis, Rotterdam, the Netherlands

Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is superior to angiography-guided PCI. The clinical uptake of FFR has been limited, however, by the need to advance a wire in the coronary artery, the additional time required and the need for hyperaemic agents which can cause patient discomfort. FFR derived from routine coronary angiography eliminates these issues.

Aims: The aim of this study was to assess the diagnostic performance and accuracy of three-dimensional quantitative coronary angiography (3D-QCA)-based vessel FFR (vFFR) compared to pressure wire-based FFR (≤0.80).

Methods: The FAST II (Fast Assessment of STenosis severity) study was a prospective observational multicentre study designed to evaluate the diagnostic accuracy of vFFR compared to the reference standard (pressure wire-based FFR ≤0.80). A total of 334 patients from six centres were enrolled. Both site-determined and blinded independent core lab vFFR measurements were compared to FFR.

Results: The core lab vFFR was 0.83±0.09 and pressure wire-based FFR 0.83±0.08. A good correlation was found between core lab vFFR and pressure wire-based FFR (R=0.74; p<0.001; mean bias 0.0029±0.0642). vFFR had an excellent diagnostic accuracy in identifying lesions with an invasive wire-based FFR ≤0.80 (area under the curve [AUC] 0.93; 95% confidence interval [CI]: 0.90-0.96; p<0.001). Positive predictive value, negative predictive value, diagnostic accuracy, sensitivity and specificity of vFFR were 90%, 90%, 90%, 81% and 95%, respectively.

Conclusions: 3D-QCA-based vFFR has excellent diagnostic performance to detect FFR ≤0.80. The study was registered on under identifier NCT03791320.

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