ACC 26: FAST III — FFR vs vFFR to Guide Revascularization

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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.


Editor: Jordan Rance
Videographer: David Ben-Harosh


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

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