FAST III
Angiography-Based vFFR vs Invasive Pressure Wire-Based FFR for Guiding Coronary Revascularization
Presented by Joost Daemen — Erasmus Medical Center
Subspecialty: Interventional
Published in NEJM
Key Result
Angiography-based vFFR was noninferior to pressure wire-based FFR for guiding coronary revascularization: identical 1-year MACE rates with shorter procedures, less radiation, and less contrast.
What did this trial find?
FAST III was a multicenter randomized trial of 2,235 patients comparing angiography-based vFFR to invasive pressure wire-based FFR for guiding coronary revascularization. The trial met its primary noninferiority endpoint with identical 1-year MACE rates, while vFFR offered procedural advantages including less radiation, contrast, and shorter procedure times. Published in NEJM and presented at ACC 2026, the results validate vFFR as a safe, less invasive alternative. Coverage is mostly straightforward and industry-driven, with no independent expert commentary or editorial counterpoints found in the source material.
Why does this trial matter?
Mostly straightforward coverage. All available quotes come from the principal investigator or industry partners (Pie Medical Imaging, Siemens Healthineers) who funded the trial. No independent expert commentary, editorial counterpoints, or critical reactions were found in the source material. There is no accompanying NEJM editorial or independent discussant commentary available.
Study Design
Investigator-initiated, multicenter, randomized trial at 37 centers (N=2,235)
Clinical Implications
Validates angiography-based vFFR as a safe and effective wire-free alternative to invasive FFR, potentially enabling broader reimbursement and increased use of physiologic lesion assessment in intermediate coronary stenoses.
Abstract
FAST III was an investigator-initiated, multicenter randomized trial evaluating angiography-based vessel Fractional Flow Reserve (vFFR) vs invasive pressure wire-based FFR in 2,235 patients with intermediate coronary lesions (30-80% stenosis) at 37 sites. The primary composite endpoint of all-cause death, MI, or any revascularization at 1 year met noninferiority, with identical MACE rates between groups. vFFR offered reduced need for guiding catheters, hyperemic agents, lower radiation dose, less contrast use, and reduced procedure time compared to wire-based FFR.