Fractional Flow Reserve and Intravascular Ultrasound RelationShip STudy (FIRST)
This study has been completed.
Information provided by (Responsible Party):
First received: June 28, 2010
Last updated: February 27, 2015
Last verified: January 2015
This is a multi-center, prospective registry of patients with intermediate coronary lesions defined as a stenosis of 40-80% by angiography. Approximately 300 patients will be enrolled into the study at sites in the United States and Europe. There will be no follow up beyond hospital discharge in this study. A sub-group of 30 patients will undergo Adenosine MRI. The investigators hypothesize that Intravascular Ultrasound Radiofrequency (IVUS RF) anatomical criteria, such as minimal luminal area, plaque burden and virtual histology plaque type, can predict physiological ischemia by Fractional Flow Reserve (FFR).
||Observational Model: Cohort
Time Perspective: Prospective
||Fractional Flow Reserve and Intravascular Ultrasound RelationShip STudy: The FIRST Study
Primary Outcome Measures:
Secondary Outcome Measures:
- Correlation between FFR and IVUS and VH parameters [ Time Frame: Day of Procedure ] [ Designated as safety issue: No ]
Correlation between FFR and various IVUS measurements (MLA,area stenosis, lesion length, plaque burden) and VH parameters (plaque type and presence of a TCFA)
- Association of FFR and Cut-off of MLA [ Time Frame: Day of Procedure ] [ Designated as safety issue: No ]
Assess the association between FFR <0.75 and 0.8 and determined cut-off of MLA with presence of a Thin Cap Fibro-Atheroma(TCFA) and/or plaque burden ≥70%
- Identify risk score model [ Time Frame: 1 year ] [ Designated as safety issue: No ]
To identify a risk score model taking into account IVUS measurements (MLA, plaque burden, area stenosis, lesion length) and VH parameters (plaque type and presence of TCFA) associated with FFR < 0.8
| Study Start Date:
| Study Completion Date:
| Primary Completion Date:
||June 2012 (Final data collection date for primary outcome measure)
Intermediate coronary lesions
Diagnostic device: FFR
Diagnostic device: IVUS RF
At participating centers, FFR and IVUS are standard of care diagnostic procedures for patients with intermediate (40-80% angiographic stenosis by visual estimate). Both modalities were used regularly for such patients whether or not they are participants in this clinical study. In FIRST, the decision to perform percutaneous coronary intervention (PCI) was left to the discretion of the investigator, and was not dictated by the clinical protocol.
Patients undergoing cardiac catheterization must meet clinical inclusion and exclusion criteria and sign an informed consent. At the time of catheterization the patients will be further analyzed for eligibility using angiographic inclusion and exclusion criteria. Patients who fulfilled the clinical and angiographic criteria will undergo further imaging evaluation using an IVUS RF catheter (Volcano Therapeutics) and FFR wire (Radi or Volcano). The decision for treatment of any lesion will be at the operator's discretion. For patients enrolled at Washington Hospital Center and do not undergo percutaneous coronary intervention, an assessment with non invasive perfusion adenosine MRI also be performed.
|Ages Eligible for Study:
||18 Years to 75 Years (Adult, Senior)
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
Patients required to have an intermediate coronary lesion (stenosis 40-80% by visual estimate) in one or more native, major epicardial coronary artery with reference diameter ≥2.5mm (visual estimate)
- Sign written informed consent to participate in the study.
- Clinical indication for coronary angiography for stable or unstable angina
Specific Angiographic Inclusion Criteria:
- Patients required to have an intermediate coronary lesion (stenosis 40-80% by visual estimate) in one or more native, major epicardial coronary artery with reference diameter ≥2.5mm (visual estimate)
- The vessel(s) with the intermediate lesion must have no flow limiting lesions and must be available for imaging and must be considered safe for imaging evaluation.
- Patient has had a documented acute ST-segment elevation myocardial infarction within the past 24 hours
- Decompensated heart failure or hypotension requiring intubation, inotropes, intravenous diuretics or intraaortic balloon counterpulsation.
- Renal dysfunction (creatinine clearance < 60 mL/min/1.73m2)
- Pregnancy or breast-feeding
- Standard contra-indications to MRI for implanted ferro-magnetic devices - i.e.: pacemakers, defibrillator (AICD), and aneurysm clips
- Body weight > 400lbs
- Left ventricular hypertrophy >1.5cm by by echocardiogram
- History of bronchospasm or asthma
- ECG evidence of conduction defect, including 2nd or 3rd degree AVB
- Patient has a known hypersensitivity, allergy or contraindication to gadolinium-based contrast agents.
- Prior participation in this study or patient is currently enrolled in another investigational use device or drug study that has not reached its primary endpoint. If the patient is enrolled in another study that is not investigational, required visits for that trial must not interfere with the conduct of this trial.
Angiographic Exclusion Criteria:
- Unprotected left main lesion location.
- Ostial lesion
- Angiographic evidence of severe calcification or marked tortuosity of the target vessel that would preclude safe imaging
- Lesion is located within or distal to an arterial or saphenous vein graft.
- Angiographic presence of thrombus in the lesion or vessel studied.
- Lesion in a vessel with <2.5 mm reference diameter or with more than one lesion in the vessel
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01153555
|Washingtoon Hospital Center
|Washington, District of Columbia, United States, 20010 |
||Ron Waksman, MD
||Washington Hospital Center
Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T, Tugaoen J, DeVries J, Palmer N, Haude M, Swymelar S, Torguson R. FIRST: Fractional Flow Reserve and Intravascular Ultrasound Relationship Study. J Am Coll Cardiol. 2013 Mar 5;61(9):917-23. doi: 10.1016/j.jacc.2012.12.012. Epub 2013 Jan 23. Erratum in: J Am Coll Cardiol. 2015 Jul 21;66(3)335.
History of Changes
|Other Study ID Numbers:
|Study First Received:
||June 28, 2010
||February 27, 2015
||United States: Institutional Review Board
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on October 21, 2016
Coronary Artery Disease
Arterial Occlusive Diseases