vFFR Demonstrates Comparable Outcome to Standard FFR in FAST-III Trial

March 29, 2026—A novel, minimally invasive method for assessing coronary lesion physiology using vessel fractional flow reserve (vFFR) demonstrated outcomes comparable to conventional fractional flow reserve (FFR) in the randomized FAST-III trial, presented at the American College of Cardiology’s Annual Scientific Session (ACC.26), according to a company press release.

The findings address a key limitation in current practice, where guideline-recommended FFR remains underused due to procedural complexity, cost, and the need for pharmacologic hyperemia. By relying on three-dimensional angiographic image reconstruction and computational modeling, vFFR eliminates the need for pressure wires and vasodilator drugs, potentially broadening physiologic assessment in patients with coronary artery disease.

In the multicountry European trial, 2,235 patients with intermediate coronary lesions were randomized to undergo either conventional FFR- or vFFR-guided assessment. The cohort had a mean age of 67 years, 24% were women, and most presented with stable angina, while 19% had acute coronary syndromes or were considered high risk.

At 1 year, the primary composite endpoint of all-cause death, myocardial infarction, or repeat revascularization occurred in 7.5% of patients in both groups. Study vessel failure, the key secondary endpoint, occurred in 4% of patients in the vFFR group compared with 4.6% in the FFR group. Investigators reported that patients with positive test results in either arm underwent revascularization with percutaneous coronary intervention or bypass surgery.

“Our new method produced very similar outcomes at 1 year compared with the standard of care,” said Joost Daemen, MD, PhD, with Erasmus University Medical Center in Rotterdam, the Netherlands. “We have also shown that this technique can easily be incorporated into routine clinical practice.”

The FAST-III trial was not blinded, and a relatively small proportion of patients presented with acute myocardial infarction, which investigators cited as limitations. The study was funded by Pie Medical Imaging and Siemens Healthineers AG, and results were published simultaneously in the New England Journal of Medicine.

Further analyses are planned to evaluate whether vFFR offers cost advantages compared with conventional FFR, which may influence broader adoption in clinical practice.