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ACIST-FFR: Microcatheter FFR produces similar results to standard system
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A microcatheter fractional flow reserve system demonstrated similar results to standard pressure wire systems for assessment of lesion characteristics in patients with stable CAD, according to results presented at EuroPCR.
For the ACIST-FFR study, researchers evaluated 245 patients with stable CAD who underwent FFR with a standard pressure-wire system and the microcatheter system (Navvus, Acist Medical Systems). The primary endpoint was difference in FFR values as determined by Bland-Altman plot.
“FFR has been shown to improve outcomes and costs compared with an angiography-guided approach, but the uptake and use of FFR has lagged behind the robustness of the supporting data,” Matthew J. Price, MD, director of the cardiac catheterization laboratory at Scripps Clinic, La Jolla, California, and a member of the Cardiology Today’s Intervention Editorial Board, said in an interview. “The advantage of the pressure-monitoring microcatheter is that it is very convenient, because the operator can advance this catheter over their own favorite coronary workhorse wire, rather than having to use a pressure wire that does not have the same characteristics or robustness of the standard coronary wire. Compared with a pressure wire, a catheter-based system is easier to manipulate to equalize, do pull-backs, check for drift and repeat measurements.”
Price presented results from 169 patients who had complete FFR core laboratory data. Mean lesion length was 15.3 mm, mean reference vessel diameter was 2.8 mm (30% of patients < 2.5 mm) and mean diameter stenosis was 47%.
Compared with a standard pressure wire, the microcatheter system provided consistent and modestly lower FFR measurements (mean difference, –0.022; 95% CI, –0.029 to –0.015).
Mean pressure drift was 0.015 for both systems (P = .44) while clinically significant pressure drift was numerically higher with the standard pressure-wire system (7.4% vs. 3.5%; P = .1), Price and colleagues found.
“We found that the pressure monitoring microcatheter provided a modestly lower FFR value compared with the traditional pressure wire, and the strongest predictor of there being a difference between the two was the physiological severity of the lesion,” Price told Cardiology Today’s Intervention. “So, the lower the FFR, the greater the differences would be. Importantly, that means the clinical impact of the difference should be minimal across most measurements. Therefore, the technology is a great asset for the operator who wants to perform FFR in a convenient fashion and allows FFR to be more broadly used.” – by Erik Swain
Reference:
Price MJ, et al. FFR: Trials and new techniques. Presented at: EuroPCR; May 16-19, 2017; Paris.
Disclosure: The study was funded by Acist Medical Systems. Price reports receiving consultant and speaker fees from Acist Medical Systems, Medtronic and St. Jude Medical.