Fractional flow reserve

Yes, uh, of course.

So a FFRct is an estimation of the fractional flow, flow reserve calculated using computational fluid dynamics, and it is based on the images that we have obtained from the CTA scan, so it does not require the patient to come to the hospital for any additional tests, and we know that it correlates very well with invasive FFR.

So why can't we just estimate the stenosis visually during angiography? Um, well, it turns out that is actually really, really hard to do.

For example, if you have a stenosis in a vessel which supplies a large amount of myocardium, then even a lower grade stenosis may actually induce a large reduction in flow as opposed to, for example, a higher grade stenosis, uh, in a vessel which do not supply a large amount of myocardium.

That stenosis may not induce a significant reduction in flow.

So it is really difficult to just visually assess whether or not flow is compromised by just looking at thing.

And thus, I think we need to have either FFRct or invasive FFR.

But in the stable coronary artery disease patient population, where almost all of them have a CTA prior to the cath lab, it just makes really good sense to perform the FFRct because then you already know prior to them coming to the cath lab which stenosis should be treated and which should not.

So it, it's, it's something that we will revisit over and over again.

But I mean, even with the coronary CT angiography, now there's some AI modeling and looking at ulcers and, you know, FFR and all these kind of things, and they still, from that, it's still hard to predict who's gonna have an event, you know? So I think it's just a really tricky thing to know who will and won't have an event, and, you know, just, just hedging it all on a calcium score just seems silly when you think about it that way.

Yeah.

And the other thing that I should caveat my, my thinking with is, you know, this is just based on this study, not subject matter expertise in coronary artery calcium scores-

Along the journey, and we can talk a little bit more about this as we kind of chat today, but we also then took that first, I would say, beachhead technology slash application space and looked at how to expand the utility of this product and move towards a platform.

And in that regard, we then developed a non-invasive physiology assessment product that we refer to as X1-FFR, fractional flow reserve.

And this was really a next generation non-invasive assessment of whether or not the restriction that's in a coronary artery is significant enough physiologically and it meets a criteria for revascularization or stenting.

And so that was the second product that we launched and developed and then launched under the Spectrowave banner and now under Philips.

Now, my comments are short.

Indeed, FFR-guided complete revascularization is likely better, but for the same reason FFR is almost always better.

It reduces the amount of stents in the body.

There were nearly 50% fewer PCI procedures in the FF arm.

Previously brought to you by clinicaltrialresults.com with C. Michael Gibson and TCTMD's Beyond the Data with our senior clinical editor, Mama's Mamas.

Mike Gibson, Bill Farron, and we're talking about the five-year results comparing angiographic or FFR-guided, rather, PCI versus CABG.

Talk to us about what you found, Bill.

Thanks, Mike.

You need longer follow-up.

You'll start to see more MIs, more death in the PCI arm.

And so that was the goal of FAME III was to look at five-year outcomes, hard endpoints, death, stroke, or MI between FFR-guided PCI and CABG.

And what did you see?