Fractional Flow Reserve or 3D-Quantitative-Coronary-Angiography Based Vessel-FFR Guided Revascularization

NCT ID: NCT04931771

Last Updated: 2023-10-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

2228 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-09

Study Completion Date

2025-05-31

Brief Summary

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The FAST III is a randomized controlled, open-label, multicenter, international, non-inferiority, strategy trial. A total of 2228 participants will be randomized in a 1:1 fashion to either vFFR- or FFR guided revascularization. Patients will be consented prior to the procedure and then followed up to 12 (+1) months after randomization. The primary endpoint is analyzed at 12 months after randomization. Approximately 35 sites in 7 European countries (Netherlands, Ireland, United Kingdom, Germany, Italy, Spain, and France).

Detailed Description

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The FAST III is a randomized controlled, open-label, multicenter, international, non-inferiority, strategy trial of a vFFR guided strategy as compared to a FFR guided strategy to guide coronary revascularization in 2228 subjects with intermediate coronary artery lesions.

Patients are screened for inclusion/exclusion criteria after the indication for coronary catheterization is established. After providing informed consent, patients are enrolled. Randomization is performed in the randomization module of the EDC system with an allocation ratio of 1:1 and stratification by center. The primary endpoint is a composite of all-cause death, any myocardial infarction, or any revascularization at 1 year post-randomization.

All deaths and major cardiovascular events, including the individual components of primary and secondary endpoints are adjudicated by an independent Clinical Events Committee (CEC), using standardized definitions. An independent Data and Safety Monitoring Board (DSMB) will formally review the accumulating data to ensure there is no avoidable increased risk for harm to participants. The FAST III trial is performed in accordance with the Declaration of Helsinki, Good Clinical Practice (GCP), ISO 14155:2020, EC requirements and country specific regulations.

Conditions

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Coronary Artery Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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vFFR guided revascularization

Group Type EXPERIMENTAL

vFFR guided revascularization

Intervention Type DEVICE

3D-angio-based vessel FFR (CAAS, Pie Medical Imaging, Maastricht, The Netherlands) uses 3-Dimensional Quantitative Coronary Angiography (3D-QCA) for functional assessment of coronary stenosis. vFFR is calculated using two angiographic views with at least 30 degrees difference in rotation/angulation to generate the 3D reconstruction of the coronary artery.

FFR guided revascularization

Group Type ACTIVE_COMPARATOR

FFR guided revascularization

Intervention Type DEVICE

Fractional flow reserve (FFR) is a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis (narrowing, usually due to atherosclerosis) to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle (myocardial ischemia)

Interventions

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vFFR guided revascularization

3D-angio-based vessel FFR (CAAS, Pie Medical Imaging, Maastricht, The Netherlands) uses 3-Dimensional Quantitative Coronary Angiography (3D-QCA) for functional assessment of coronary stenosis. vFFR is calculated using two angiographic views with at least 30 degrees difference in rotation/angulation to generate the 3D reconstruction of the coronary artery.

Intervention Type DEVICE

FFR guided revascularization

Fractional flow reserve (FFR) is a technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis (narrowing, usually due to atherosclerosis) to determine the likelihood that the stenosis impedes oxygen delivery to the heart muscle (myocardial ischemia)

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. The patient must be ≥18 years of age
2. Presenting with silent ischemia, stable angina, or non-ST-elevation acute coronary syndrome (NSTE-ACS)
3. Coronary artery disease with at least one native artery in which the stenosis severity is questionable (typically 30-80% stenosis)
4. FFR assessment and vFFR assessment feasible
5. The patient is willing and able to cooperate with study procedures and follow-up until study completion
6. Subject is able to confirm understanding of risks, benefits and treatment alternatives and he/she provides informed consent prior to any protocol-related procedure, as approved by the appropriate Ethics Committee

Exclusion Criteria

1. ST-elevation myocardial infarction (STEMI) at presentation
2. Cardiogenic shock or severe hemodynamic instability at the time of intervention (heart rate\<50 beats per minute, systolic blood pressure \<90mmHg) or use of left ventricular assist device
3. Any target vessel with a distal Thrombolysis In Myocardial Infarction (TIMI) flow \<3.
4. Presence of thrombus in intermediate target lesion.
5. Known untreated severe valvular heart disease
6. Target lesion is located in or supplied by an arterial or venous bypass graft
7. History of cardiac allograft transplantation
8. Aorto-ostial lesions with an estimated diameter stenosis \>50%
9. Severe tortuosity precluding the acquisitions of 2 orthogonal projections of the target vessel with minimal overlap or foreshortening.
10. Absolute contraindications or allergy that cannot be pre-medicated, to iodinated contrast or adenosine
11. Non-cardiac co-morbidities with a life expectancy less than 1 year
12. Currently participating in another trial that is not yet at its primary endpoint. The patient is not allowed to participate in another investigational device or drug study until the trial primary endpoint time point is achieved and may only be enrolled once in the study
13. Women of childbearing potential who do not have a negative pregnancy test within 24 hours before the procedure
14. Subject belongs to a vulnerable population (per Investigator's judgment) or subject unable to read or write
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Siemens Healthineers AG

UNKNOWN

Sponsor Role collaborator

Pie Medical Imaging

UNKNOWN

Sponsor Role collaborator

ECRI bv

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Joost Daemen, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Erasmus Medical Center

Ernest Spitzer, MD

Role: STUDY_DIRECTOR

European Cardiovascular Research Institute

Locations

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Clinique St Martin

Caen, , France

Site Status RECRUITING

Institut Cardiovasculaire de Grenoble

Grenoble, , France

Site Status NOT_YET_RECRUITING

CHU LILLE - Institut Cœur Poumon

Lille, , France

Site Status RECRUITING

Hôpital de la Croix Rousse, hospices civils de lyon

Lyon, , France

Site Status RECRUITING

Hôpital Privé Jacques Cartier

Massy, , France

Site Status NOT_YET_RECRUITING

Clinique les Fontaines

Melun, , France

Site Status RECRUITING

Clinique Saint Hilaire

Rouen, , France

Site Status RECRUITING

Herz- und Diabeteszentrum NRW

Bad Oeynhausen, , Germany

Site Status RECRUITING

Charité- Campus Benjamin Franklin

Berlin, , Germany

Site Status RECRUITING

Unfallkrankenhaus Berlin

Berlin, , Germany

Site Status RECRUITING

Universitatsklinikum Dusseldorf

Düsseldorf, , Germany

Site Status NOT_YET_RECRUITING

Marienhaus Klinikum

Neuwied, , Germany

Site Status RECRUITING

SHG Klinik Völklingen

Völklingen, , Germany

Site Status RECRUITING

Mater Private Cork

Cork, , Ireland

Site Status RECRUITING

Beaumont Hospital

Dublin, , Ireland

Site Status WITHDRAWN

Mater Private Dublin

Dublin, , Ireland

Site Status RECRUITING

St James Hospital

Dublin, , Ireland

Site Status RECRUITING

Azienda Ospedaliera Papa Giovanni XXIII

Bergamo, , Italy

Site Status RECRUITING

AOU di Ferrara (Ospedale Sant'Anna)

Cona, , Italy

Site Status RECRUITING

Cardiologia Ospedale Dell' Angelo

Mestre, , Italy

Site Status RECRUITING

Humanitas Research Hospital

Milan, , Italy

Site Status RECRUITING

Policlinico San Donato

Milan, , Italy

Site Status RECRUITING

Pineta Grande Hospital

Naples, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Maggiore della Carità

Novara, , Italy

Site Status RECRUITING

AOU Verona

Verona, , Italy

Site Status WITHDRAWN

Cardiologia Ospedale San Bortolo

Vicenza, , Italy

Site Status RECRUITING

Tergooi MC

Blaricum, , Netherlands

Site Status RECRUITING

Amphia Ziekenhuis

Breda, , Netherlands

Site Status RECRUITING

Albert Schweitzer

Dordrecht, , Netherlands

Site Status RECRUITING

Erasmus University Medical Center

Rotterdam, , Netherlands

Site Status RECRUITING

UMCU

Utrecht, , Netherlands

Site Status RECRUITING

Hospital Univeritario A Coruna

A Coruña, , Spain

Site Status RECRUITING

Hospital Clinic

Barcelona, , Spain

Site Status RECRUITING

Hospital del Mar

Barcelona, , Spain

Site Status RECRUITING

Hospital Universitario de Leon

León, , Spain

Site Status NOT_YET_RECRUITING

Hospital Universitario de la Princesa

Madrid, , Spain

Site Status RECRUITING

La Paz

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario Central de Asturias

Oviedo, , Spain

Site Status RECRUITING

Hospital Clinico Universitario de Valladolid

Valladolid, , Spain

Site Status RECRUITING

Royal Victoria Hospital

Belfast, , United Kingdom

Site Status WITHDRAWN

Royal Sussex County Hospital

Brighton, , United Kingdom

Site Status RECRUITING

Golden Jubilee National Hospital

Glasgow, , United Kingdom

Site Status RECRUITING

John Radcliffe Hospital

Oxford, , United Kingdom

Site Status RECRUITING

Countries

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France Germany Ireland Italy Netherlands Spain United Kingdom

Central Contacts

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Ernest Spitzer, MD

Role: CONTACT

+31102062828

Monique Schuijer, PhD

Role: CONTACT

+31102062828

Facility Contacts

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Joost Daemen, MD, PhD

Role: primary

References

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Scoccia A, Byrne RA, Banning AP, Landmesser U, Van Belle E, Amat-Santos IJ, Sabate M, Tijssen JGP, Spitzer E, Daemen J. Fractional flow reserve or 3D-quantitative-coronary-angiography based vessel-FFR guided revascularization. Rationale and study design of the prospective randomized fast III trial. Am Heart J. 2023 Jun;260:1-8. doi: 10.1016/j.ahj.2023.02.003. Epub 2023 Feb 14.

Reference Type DERIVED
PMID: 36796573 (View on PubMed)

Other Identifiers

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ECRI-15

Identifier Type: -

Identifier Source: org_study_id

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