American College of Cardiology Congress 2026 - Dr Joost Daemen (Thoraxcenter, Erasmus University Medical Center, Rotterdam, NL) joins us to discuss findings from the FAST III trial (NCT04931771; ECRI) a large-scale randomised study comparing fractional flow reserve (FFR) with 3D-quantitative coronary angiography-derived vessel FFR (vFFR) to guide coronary revascularisation.

This randomised, open-label, multicentre, international non-inferiority trial enrolled 2,228 patients with intermediate coronary artery lesions across approximately 35 sites in 7 European countries. Patients were randomised 1:1 to either an FFR- or vFFR-guided revascularisation strategy with the primary endpoint of all-cause death, myocardial infarction or any revascularisation at 12 months.

At one year, findings showed that vFFR-guided revascularization was noninferior to an FFR-guided strategy in regard to the composite endpoint of death, myocardial infarction or revascularization.

Interview Questions:

1. What are the current limitations of pressure wire-based FFR in routine clinical practice and what is the rationale for exploring angiography-derived alternatives?
2. What were the aims of the FAST III trial and how was it designed?
3. What were the key findings?
4. What are the clinical implications for interventional cardiologists considering a wire-free physiology strategy?
5. What are your take-home messages for clinicians performing PCI?
6. What are the next steps for this research?

Recorded on-site at ACC.26, New Orleans.

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Editor: Jordan Rance
Videographer: David Ben-Harosh

Support: This is an independent interview produced by Radcliffe Cardiology.