Coronary Artery DiseasePhase 4NCT05437900
INSIGHTFUL-FFR Clinical Trial
A Phase 4 study testing Pressure Microcatheter guided strategy - PIOS MC and Pressure Wire guided strategy - PIOS - PW in people with Coronary Artery Disease and Acute Coronary Syndrome, run by CoreAalst BV at 29 sites in 8 countries.
Trial summary
Recently, a new device for measuring physiological lesion severity, the pressure microcatheter, was introduced. The pressure microcatheter provides similar information to the conventional measurement technique but differs as it is easily advanced on a customary coronary wire and simplifies pullback maneuvers. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Coronary Artery Disease, Acute Coronary Syndrome
- What is being tested?
- Pressure Microcatheter guided strategy - PIOS MC and Pressure Wire guided strategy - PIOS - PW
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 2,500 participants
- Where
- 29 sitesin 8 countries
- Study dates
- 22 Sep 2022to 30 Jun 2030
- Phase
- Phase 4
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- The subject must be at least 18 years of age and younger than 85 years old.
- Eligible for elective PCI.
- Stable angina or ACS (non-culprit vessels only and outside of primary intervention during acute STEMI)
- Subject willing to participate and able to understand, read and sign the Informed Consent.
Who cannot join
- STEMI as clinical presentation.
- Chronic total occlusion as a target vessel.
- Significant contraindication to adenosine administration (e.g. heart block, severe asthma)
- Uncontrolled or recurrent ventricular tachycardia.
- Hemodynamic instability.
- Severe valvular disease.
Show all 20Show fewer
- Severe renal dysfunction defined as an eGFR ≤30 mL/min/1.73 m2.
- Comorbidity with life expectancy ≤ 2 years.
- Inability to take DAPT (both aspirin and a P2Y12 inhibitor) for at least 12 months in the patient presenting with an ACS, or at least six months in the patient presenting with stable CAD, unless the patient is also taking chronic oral anticoagulation in which case a shorter duration of DAPT may be prescribed per local standard of care.
- Planned major cardiac or non-cardiac surgery within 24 months after the index procedure. Note: major surgery is any invasive procedure in which an extensive resection is performed, e.g., a body cavity is entered, organs are removed, or normal anatomy is altered. Note: minor surgery is an operation on the superficial structures of the body or a manipulative procedure that does not involve a serious risk. Planned minor surgery is not excluded.
- Subject has known hypersensitivity or contraindication to any of the study drugs (including all P2Y12 inhibitors, one or more components of the study devices, including everolimus, zotarolimus, biolimus, sirolimus, cobalt, chromium, nickel, platinum, tungsten, acrylic, and fluoropolymers, or radiocontrast dye that cannot be adequately pre- medicated.
- The subject has received a functioning solid organ transplant or is active on a waiting list for any solid organ transplants with expected transplantation within 24 months.
- The subject receives immunosuppressant therapy or has known immunosuppressive or severe autoimmune disease that requires chronic immunosuppressive therapy (e.g., human immunodeficiency virus, systemic lupus erythematosus, etc.). Note: corticosteroids are not included as immunosuppressant therapy.
- The subject has previously received or is scheduled to receive radiotherapy to a coronary artery (vascular brachytherapy) or the chest/mediastinum.
- Subject has a platelet count <100,000 cells/mm3 or >700,000 cells/mm3.
- The subject has a documented or suspected hepatic disorder defined as cirrhosis or Child-Pugh ≥ Class B.
- The subject has a history of bleeding diathesis or coagulopathy or has had a significant gastro-intestinal or significant urinary bleed within the past six months. The subject has had a cerebrovascular accident or transient ischemic neurological attack (TIA) within the past six months, any prior intracranial bleed, any permanent neurologic defect, or any known intracranial pathology (e.g., aneurysm, arteriovenous malformation, etc. The subject has a life expectancy of <2 years for any non-cardiac cause.
- The subject is currently participating in another investigational drug or device clinical study.
- Pregnancy or nursing.
- Presence of other anatomic or comorbid conditions or other medical, social, or psychological conditions that, in the investigator's opinion, could limit the subject's ability to participate in the clinical investigation or to comply with follow-up requirements or impact the scientific soundness of the clinical investigation results.
Trial locations and contacts
29 sites in 8 countries. Contact the study team or a site near you to ask about taking part.
29 sites in 8 countries
Germany6 sites, 5 recruiting
- Recruiting
Herzzentrum Dresden
Dresden
Felix Woitek, MD
Felix Woitek
- Recruiting
Klinikum Fürth
Fürth
Stylianos Pyxaras, MD,PhD
Stylianos Pyxaras, MD, PhD
- Recruiting
Klinikum Herford
Herford
Dominik Gorski, MD
Dominik Gorski, MD
- Active, not recruiting
Catholic Medical Center Koblenz-Montabaur
Koblenz
- Recruiting
Herzzentrum Lahr
Lahr
Kambis Mashayekhi, MD, PhD
Kambis Mashayekhi, MD, PhD
- Recruiting
Universitätsklinik
Mainz
Tommaso Gori, MD, PhD
Tommaso Gori, MD, PhD
Italy5 sites, 5 recruiting
- Recruiting
Nuovo Arcispedale S.Anna Di Ferrara
Ferrara
Gianluca Campo, MD
Gianluca Campo, MD
- Recruiting
Ospedale Civile Sant'Andrea
La Spezia
Marco Arena, MD
Marco Arena
- Recruiting
Ospedale Santa Maria Goretti
Latina
Iginio Colaiori, MD
Iginio Colaiori, MD
- Recruiting
Azienda Ospedaliera Universitaria Federico II
Naples
Giovanni Esposito, MD
Giovanni Esposito, MD
- Recruiting
Azienda Ospedaliera Universitaria Sant'Andrea
Rome
Emanuele Barbato, MD
Emanuele Barbato, MD
Belgium3 sites, 3 recruiting
- Recruiting
OLV Aalst
Aalst, Oost-Vlaanderen, 9300
Hilde Delacroix, hilde.delacroix@olvz-aalst.be
Carlos Collet, MD, PhD
- Recruiting
Universitair ziekenhuis Brussel
Brussels
Marnix von Kemp, Md
Marnix von Kemp, MD
- Recruiting
ZOL
Genk
Daan Cottens, MD
Daan Cottens, MD
China3 sites
- Active, not recruiting
QILU Hospital of Shandong University
Shandong
- Active, not recruiting
Zhongshan Hospital of Fudan University
Shanghai, Xuhui District, 200031
- Active, not recruiting
West China Hospital of Sichuan University
Sichuan
France3 sites, 2 recruiting
- Recruiting
CHU Lille
Lille
Eric Van Belle, MD
Eric Van Belle, MD
- Active, not recruiting
Claude Bernard University
Lyon
- Recruiting
ICPS
Paris
Nicolas Amabile, MD
Nicolas Amabile, MD
Netherlands3 sites, 3 recruiting
- Recruiting
Amsterdam UMC
Amsterdam
Marcel Beijk, MD
Marcel Beijk, MD
- Recruiting
Catharina Ziekenhuis
Eindhoven
Pim Tonino, MD
Pim Tonino, MD
- Recruiting
UMCN Radboud
Nijmegen
Lokien Van Nunen, MD
Lokien Van Nunen, MD
Poland3 sites, 3 recruiting
- Recruiting
Dr. Jurasz University Hospital No. 1
Bydgoszcz
Adam Sukiennik, MD
Adam Sukiennik
- Recruiting
John Paul II Specialistic Hospital
Krakow
Jacek Legutko, MD
Jacek Legutko, MD
- Recruiting
National Cardiac Institute
Warsaw
Adam Witkowski, MD, PhD
Adam Witkowski, MD, PhD
Spain3 sites, 3 recruiting
- Recruiting
Hospital Clínic Barcelona
Barcelona, 08036
Salvatore Brugaletta, MD, PhD
Salvatore Brugaletta, MD, PhD
- Recruiting
Germans Trias i Pujol Hopital
Barcelona
Oriol Rodriguez, MD
Oriol Rodriguez, MD
- Recruiting
Hospital de Belvitge
Barcelona
Josep Gomez Lara, MD
Josep Gomez Lara
About this study
Official title: Pressure Microcatheter vs Pressure Wire for Clinical Decision Making and PCI Optimization
Recently, a new device for measuring physiological lesion severity, the pressure microcatheter, was introduced. The pressure microcatheter provides similar information to the conventional measurement technique but differs as it is easily advanced on a customary coronary wire and simplifies pullback maneuvers. The pressure microcatheter has been shown to provide comparable FFR results to pressure wires.
Insightful-FFR is an investigator-driven, multicenter, randomized, open-label and prospective trial of patients with stable coronary artery disease or stabilised non-ST elevation acute coronary syndrome (ACS) with epicardial stenosis considered for PCI aiming at comparing clinical outcomes between pressure microcatheter and pressure wire-guided strategies. The study hypothesis states that the use of a Pressure Microcatheter for clinical decision making would be non-inferior to pressure wire-based strategy
After determining the presence of a coronary artery disease/ stabilized acute coronary syndrome, patients will be randomized to use a pressure microcatheter (investigational device) or a pressure wire (comparator) to guide and optimize percutaneous coronary intervention (PCI). Patients will be followed up in hospital at 12 months and yearly until five years.
- Conditions
- Coronary Artery Disease, Acute Coronary Syndrome
- Being tested
- Pressure Microcatheter guided strategy - PIOS MC, Pressure Wire guided strategy - PIOS - PW, Pressure Microcatheter guided strategy - Standard of care, Pressure Wire guided strategy - Standard of care
- Keywords
- Percutaneous Coronary intervention (PCI)
- Medical subject headings
- Coronary Artery Disease, Acute Coronary Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Pressure Microcatheter guided strategy - PIOS MCProcedure or surgery
Use of Pressure Microcatheter during PCI. After the PCI, the patient will receive treatment according to the incremental optimization strategy (PIOS) .
Pressure Wire guided strategy - PIOS - PWProcedure or surgery
Use of Pressure Wire during PCI. After the PCI, the patient will receive treatment according to the incremental optimization strategy (PIOS) .
Pressure Microcatheter guided strategy - Standard of careProcedure or surgery
Use of Pressure Microcatheter during PCI. After the PCI, the patient will receive standard of care treatment.
Pressure Wire guided strategy - Standard of careProcedure or surgery
Use of Pressure Wire during PCI. After the PCI, the patient will receive standard of care treatment.
| Study group | Role | What they receive |
|---|---|---|
| Pressure Microcatheter guided strategy - PIOS-MC | Experimental | Patients will be treated with the Pressure Microcatheter during PCI. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS). Receives: Procedure: Pressure Microcatheter guided strategy - PIOS MC |
| Pressure Wire guided strategy - PIOS-PW | Active comparator | Patients will be treated with the Pressure Wire during PCI. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS). Receives: Procedure: Pressure Wire guided strategy - PIOS - PW |
| Pressure Microcatheter guided strategy - Standard of care | Experimental | Patients will be treated with the Pressure Microcatheter during PCI. After completing an angiographically successful PCI, patients will receive the standard of care treatment. Receives: Procedure: Pressure Microcatheter guided strategy - Standard of care |
| Pressure Wire guided strategy - Standard of care | Active comparator | Patients will be treated with the Pressure Wire during PCI. After completing an angiographically successful PCI, patients will receive the standard of care treatment. Receives: Procedure: Pressure Wire guided strategy - Standard of care |
What is being measured
The primary outcome is the main question the study is designed to answer.
Compare the rate of MACE between pressure microcatheter and pressure wire strategies.
Compare the rate of major adverse cardiovascular events (MACE) defined as the combined rate of all cause death, myocardial infarction (MI), and unplanned revascularization between pressure microcatheter and pressure wire strategies at 12-months follow-up.
Measured: 12 Months follow-up
Secondary outcomes (29)
Compare the rate of target vessel failure (TVF) between PIOS and SOC.
In patients undergoing PCI, compare the rate of target vessel failure (TVF) defined as the composite of cardiac death, target vessel MI and ischemia-driven target vessel revascularisation (ID-TVR) between PIOS and SOC.
Measured: 12 Months follow-up
Compare in-hospital resource utilization between pressure microcatheter and pressure wire strategies.
Compare in-hospital resource utilisation (cost from all the procedures during the hospitalisation to discharge in Euros) between microcatheter and pressure wire strategies i.e.number of pressure catheters/wires and procedural time needed to complete the procedure.
Measured: During the hospitalisation (from admission to the hospital until discharge after the procedure)
Compare the procedure time between pressure microcatheter and pressure-wire guided strategies in minutes.
Compare the procedure time between pressure microcatheter and pressure-wire guided strategies in minutes. This is the time from first to the last angiography in minutes.
Measured: Periprocedural time frame
Compare in-hospital resource utilisation between PIOS-MC and PIOS-PW.
In patients undergoing PCI, compare resource utilisation (cost from all the procedures during the hospitalisation to discharge in Euros, e.g. number of catheters/wires) between a pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI.
Measured: During the hospitalisation (from admission to the hospital until discharge after the procedure)
In patients undergoing PCI, compare the procedural time in minutes between pressure PIOS-MC and PIOS-PW strategies.
In patients undergoing PCI, compare the procedural time in minutes between a pressure PIOS-MC and PIOS-PW strategies.
Measured: Periprocedural time frame
Compare the post-PCI FFR between the pressure microcatheter and pressure-wire guided strategies in patients undergoing PCI.
Measured: Periprocedural time frame
Compare the post-PCI FFR between pressure PIOS and SOC strategies in patients undergoing PCI.
Measured: Periprocedural time frame
Compare the post-PCI FFR between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI.
Measured: Periprocedural time frame
Compare the proportion of FFR > 0.90 between pressure microcatheter (MC) PIOS and SOC strategies in patients undergoing PCI.
Compare the proportion of FFR > 0.90 (in percentage) between pressure microcatheter (MC) PIOS and SOC strategies in patients undergoing PCI.
Measured: Periprocedural time frame
Compare the proportion of FFR > 0.80 between pressure PIOS and SOC strategies in patients undergoing PCI.
Compare the proportion of FFR > 0.80 (in percentage) between pressure PIOS and SOC strategies in patients undergoing PCI.
Measured: Periprocedural time frame
Compare the proportion of FFR > 0.80 between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI
Compare the proportion of FFR > 0.80 (in percentage) between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI
Measured: Periprocedural time frame
Compare the proportion of FFR > 0.90 between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI.
Compare the proportion of FFR > 0.90 (in percentage) between pressure PIOS-MC and PIOS-PW
Measured: Periprocedural time frame
Compare the rate of symptoms-free status between pressure microcatheter and pressure wire strategies.
Compare the rate of symptoms-free status assessed by the Seattle Angina Questionnaire (SAQ-7) between pressure microcatheter and pressure-wire guided strategies at 12 months follow-up.
Measured: 12 Months follow-up
Compare the rate of all-cause death between pressure microcatheter and pressure-wire guided strategies.
Compare the rate of all-cause death between pressure microcatheter and pressure-wire guided strategies at 12 months follow-up
Measured: 12 Months follow-up
Compare the rate of myocardial infarction between pressure microcatheter and pressure-wire guided strategies.
Compare the rate of myocardial infarction between pressure microcatheter and pressure-wire guided strategies at 12 months follow-up
Measured: 12 Months follow-up
Compare the rate of unplanned revascularisation between pressure microcatheter and pressure-wire guided strategies.
Compare the rate of unplanned revascularisation between pressure microcatheter and pressure-wire guided strategies at 12 months follow-up
Measured: 12 Months follow-up
In patients undergoing PCI, compare the rate of cardiac death between PIOS and SOC.
In patients undergoing PCI, compare the rate of cardiac death between PIOS and SOC at 12 months follow-up
Measured: 12 Months follow-up
In patients undergoing PCI, compare the rate of target vessel myocardial infarction (MI) between PIOS and SOC.
In patients undergoing PCI, compare the rate of target vessel myocardial infarction (MI) between PIOS and SOC at 12 months follow-up.
Measured: 12 Months follow-up
In patients undergoing PCI, compare the rate of ischemia-driven target-vessel revascularization (ID-TVR) between PIOS and SOC.
In patients undergoing PCI, compare the rate of ischemia-driven target-vessel revascularization (ID-TVR) between PIOS and SOC at 12 months follow-up
Measured: 12 Months follow-up
Compare the rate of PCI-related myocardial infarction (MI) (type 4a) between pressure PIOS and SOC.
Measured: During the procedure
Compare the rate of angiographic complications between pressure microcatheter and pressure-wire guided strategies.
Compare the rate of angiographic complications related to vessel wiring (i.e., Angiographic dissection ≥ NHLBI type B, perforations (Ellis classification), intra-procedural thrombotic events (including slow-flow, no-reflow, side branch closure, distal embolization, and intra-procedural stent thrombosis, as per the standard angiographic core laboratory definitions) between pressure microcatheter and pressure-wire guided strategies.
Measured: Periprocedural time frame
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for post-PCI FFR.
Compare how close the value of PPG derived from pressure microcatheter versus pressure wire corresponds to the actual measure post-PCI FFR value.
Measured: Periprocedural time frame
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for target vessel failure (TVF).
Compare how close the value of PPG derived from pressure microcatheter versus pressure wire corresponds to the occurence of target vessel failure (TVF).
Measured: 12 Months follow-up
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for target-vessel myocardial infarction (MI).
Compare how close the value of PPG derived from pressure microcatheter versus pressure wire corresponds to the occurence of target myocardial infarction.
Measured: 12 Months follow-up
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for ischemia-driven target-vessel revascularization (ID-TVR).
Compare how close the value of PPG derived from pressure microcatheter versus pressure wire corresponds to the occurence of ischemia-driven target-vessel revascularization (ID-TVR).
Measured: 12 Months follow-up
Compare the predictive capacity of the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire for target-vessel myocardial infarction (MI).
Compare how close the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire corresponds to the occurence of target-vessel myocardial infarction (MI).
Measured: 12 Months follow-up
Compare the predictive capacity of the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire for target vessel revascularization.
Compare how close the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire corresponds to the occurence of target-vessel revascularization.
Measured: 12 Months follow-up
Compare the rate of peri-procedural myocardial infarction stratified by PPG derived from pressure microcatheter versus pressure wire.
Measured: Periprocedural timeframe
Compare the rate of peri-procedural myocardial injury stratified by PPG derived from pressure microcatheter versus pressure wire.
Measured: Periprocedural timeframe
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jun 2022
- Study start22 Sep 2022
- Primary completion30 Jun 2026 (estimated)
- Study completion30 Jun 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Coronary Artery DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Patients with one or more coronary stenoses will be randomized to either pressure microcatheter or pressure wire-based strategies for clinical decision making. Clinical decision making for PCI could be based either on FFR or NHPR. FFR or NHPR will support clinical decisions to defer or treat at the operator discretion. In cases with a positive FFR (≤ 0.80) or NHPR (≤0.89), patients will undergo a hyperemic FFR pullback to guide the PCI procedure further. PCI will be performed using last-generation drug-eluting stents (DES) at operator's discretion. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS) or standard of care (SOC). The one-step randomization process in four groups permits an uninterrupted invasive procedure avoiding the logistic issues related to a second randomization during the invasive procedure while preserving the statistical power and balance between groups.
- Masking
- None (open label)
- Enrolment
- 2,500 participants (estimated)
Sponsor and investigators
- Lead sponsor
- CoreAalst BV
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- Insight Lifetech Co., Ltd.
- Responsible party
- Sponsor
- Investigators
- Emanuele Barbato, MD, PhD, Principal investigator, Azienda Ospedaliera Universitaria Sant'Andrea, RomaCarlos Collet, MD, PhD, Principal investigator, CoreAalst BVJunbo Ge, MD, Principal investigator, Zhongshan Hospital, Fudan University, ShanghaiSalvatore Brugaletta, MD, PhD, Principal investigator, Hospital Clinic of Barcelona
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05437900
- Sponsor's protocol ID
- CA-053
- Status last verified
- Jan 2026
- First submitted
- 2 Jun 2022
- Last updated
- 12 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Stalikas N, Mizukami T, Bouisset F, Ikeda K, Tajima A, Munhoz D, Mahendiran T, Wilgenhof A, Sakai K, Noorgard B, Engstroem T, Leipsic J, Stefanini G, Bartorelli A, Fairbairn T, Bagnall A, Ko B, Johnson NP, Berry C, Perera D, Christiansen EH, Shinke T, Otake H, Koo BK, Barbato E, Brugaletta S, Collison D, Campo G, Van Belle E, Goori T, Van Nunen L, Witkowski A, Astudillo P, Spratt J, Amano T, Ando H, Sianos G, Sonck J, Andreini D, De Bruyne B, Collet C. Vessel-Specific Myocardial Mass in Patients With Stable Coronary Artery Disease. J Am Heart Assoc. 2025 Nov 18;14(22):e039013. doi: 10.1161/JAHA.124.039013. Epub 2025 Nov 6.
PubMed 41195772
Study at a glance
From the registry record, last updated by the sponsor on 12 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Pressure Microcatheter vs Pressure Wire for Clinical Decision Making and PCI Optimization
- ClinicalTrials.gov ID
- NCT05437900
- Acronym / sponsor ID
- CA-053
- Conditions
- Coronary Artery Disease, Acute Coronary Syndrome
- Keywords
- Percutaneous Coronary intervention (PCI)
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 2,500 participants (estimated)
- Lead sponsor
- CoreAalst BVIndustry (pharma, biotech, devices)
- Collaborators
- Insight Lifetech Co., Ltd.
- Study start
- 22 Sep 2022 (actual)
- Primary completion
- 30 Jun 2026 (estimated)
- Study completion
- 30 Jun 2030 (estimated)
- First posted
- 29 Jun 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Recently, a new device for measuring physiological lesion severity, the pressure microcatheter, was introduced. The pressure microcatheter provides similar information to the conventional measurement technique but differs as it is easily advanced on a customary coronary wire and simplifies pullback maneuvers. The pressure microcatheter has been shown to provide comparable FFR results to pressure wires.
Insightful-FFR is an investigator-driven, multicenter, randomized, open-label and prospective trial of patients with stable coronary artery disease or stabilised non-ST elevation acute coronary syndrome (ACS) with epicardial stenosis considered for PCI aiming at comparing clinical outcomes between pressure microcatheter and pressure wire-guided strategies. The study hypothesis states that the use of a Pressure Microcatheter for clinical decision making would be non-inferior to pressure wire-based strategy
After determining the presence of a coronary artery disease/ stabilized acute coronary syndrome, patients will be randomized to use a pressure microcatheter (investigational device) or a pressure wire (comparator) to guide and optimize percutaneous coronary intervention (PCI). Patients will be followed up in hospital at 12 months and yearly until five years.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 4
- Model description
- Patients with one or more coronary stenoses will be randomized to either pressure microcatheter or pressure wire-based strategies for clinical decision making. Clinical decision making for PCI could be based either on FFR or NHPR. FFR or NHPR will support clinical decisions to defer or treat at the operator discretion. In cases with a positive FFR (≤ 0.80) or NHPR (≤0.89), patients will undergo a hyperemic FFR pullback to guide the PCI procedure further. PCI will be performed using last-generation drug-eluting stents (DES) at operator's discretion. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS) or standard of care (SOC). The one-step randomization process in four groups permits an uninterrupted invasive procedure avoiding the logistic issues related to a second randomization during the invasive procedure while preserving the statistical power and balance between groups.
| Arm | Type | Receives |
|---|---|---|
| Pressure Microcatheter guided strategy - PIOS-MC | Experimental | Procedure: Pressure Microcatheter guided strategy - PIOS MCPatients will be treated with the Pressure Microcatheter during PCI. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS). |
| Pressure Wire guided strategy - PIOS-PW | Active comparator | Procedure: Pressure Wire guided strategy - PIOS - PWPatients will be treated with the Pressure Wire during PCI. After completing an angiographically successful PCI, patients will be randomized to FFR-guided stent optimization (PIOS). |
| Pressure Microcatheter guided strategy - Standard of care | Experimental | Procedure: Pressure Microcatheter guided strategy - Standard of carePatients will be treated with the Pressure Microcatheter during PCI. After completing an angiographically successful PCI, patients will receive the standard of care treatment. |
| Pressure Wire guided strategy - Standard of care | Active comparator | Procedure: Pressure Wire guided strategy - Standard of carePatients will be treated with the Pressure Wire during PCI. After completing an angiographically successful PCI, patients will receive the standard of care treatment. |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- The subject must be at least 18 years of age and younger than 85 years old.
- Eligible for elective PCI.
- Stable angina or ACS (non-culprit vessels only and outside of primary intervention during acute STEMI)
- Subject willing to participate and able to understand, read and sign the Informed Consent.
Key exclusion criteria (20 listed)
- STEMI as clinical presentation.
- Chronic total occlusion as a target vessel.
- Significant contraindication to adenosine administration (e.g. heart block, severe asthma)
- Uncontrolled or recurrent ventricular tachycardia.
- Hemodynamic instability.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Pressure Microcatheter guided strategy - PIOS MCUse of Pressure Microcatheter during PCI. After the PCI, the patient will receive treatment according to the incremental optimization strategy (PIOS) . | Procedure or surgery | Pressure Microcatheter guided strategy - PIOS-MC |
| Pressure Wire guided strategy - PIOS - PWUse of Pressure Wire during PCI. After the PCI, the patient will receive treatment according to the incremental optimization strategy (PIOS) . | Procedure or surgery | Pressure Wire guided strategy - PIOS-PW |
| Pressure Microcatheter guided strategy - Standard of careUse of Pressure Microcatheter during PCI. After the PCI, the patient will receive standard of care treatment. | Procedure or surgery | Pressure Microcatheter guided strategy - Standard of care |
| Pressure Wire guided strategy - Standard of careUse of Pressure Wire during PCI. After the PCI, the patient will receive standard of care treatment. | Procedure or surgery | Pressure Wire guided strategy - Standard of care |
Primary outcome
Compare the rate of MACE between pressure microcatheter and pressure wire strategies.
Time frame: 12 Months follow-up
Compare the rate of major adverse cardiovascular events (MACE) defined as the combined rate of all cause death, myocardial infarction (MI), and unplanned revascularization between pressure microcatheter and pressure wire strategies at 12-months follow-up.
29 secondary outcomes
Compare the rate of target vessel failure (TVF) between PIOS and SOC.
Time frame: 12 Months follow-up
Compare in-hospital resource utilization between pressure microcatheter and pressure wire strategies.
Time frame: During the hospitalisation (from admission to the hospital until discharge after the procedure)
Compare the procedure time between pressure microcatheter and pressure-wire guided strategies in minutes.
Time frame: Periprocedural time frame
Compare in-hospital resource utilisation between PIOS-MC and PIOS-PW.
Time frame: During the hospitalisation (from admission to the hospital until discharge after the procedure)
In patients undergoing PCI, compare the procedural time in minutes between pressure PIOS-MC and PIOS-PW strategies.
Time frame: Periprocedural time frame
Compare the post-PCI FFR between the pressure microcatheter and pressure-wire guided strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the post-PCI FFR between pressure PIOS and SOC strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the post-PCI FFR between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the proportion of FFR > 0.90 between pressure microcatheter (MC) PIOS and SOC strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the proportion of FFR > 0.80 between pressure PIOS and SOC strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the proportion of FFR > 0.80 between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI
Time frame: Periprocedural time frame
Compare the proportion of FFR > 0.90 between pressure PIOS-MC and PIOS-PW strategies in patients undergoing PCI.
Time frame: Periprocedural time frame
Compare the rate of symptoms-free status between pressure microcatheter and pressure wire strategies.
Time frame: 12 Months follow-up
Compare the rate of all-cause death between pressure microcatheter and pressure-wire guided strategies.
Time frame: 12 Months follow-up
Compare the rate of myocardial infarction between pressure microcatheter and pressure-wire guided strategies.
Time frame: 12 Months follow-up
Compare the rate of unplanned revascularisation between pressure microcatheter and pressure-wire guided strategies.
Time frame: 12 Months follow-up
In patients undergoing PCI, compare the rate of cardiac death between PIOS and SOC.
Time frame: 12 Months follow-up
In patients undergoing PCI, compare the rate of target vessel myocardial infarction (MI) between PIOS and SOC.
Time frame: 12 Months follow-up
In patients undergoing PCI, compare the rate of ischemia-driven target-vessel revascularization (ID-TVR) between PIOS and SOC.
Time frame: 12 Months follow-up
Compare the rate of PCI-related myocardial infarction (MI) (type 4a) between pressure PIOS and SOC.
Time frame: During the procedure
Compare the rate of angiographic complications between pressure microcatheter and pressure-wire guided strategies.
Time frame: Periprocedural time frame
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for post-PCI FFR.
Time frame: Periprocedural time frame
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for target vessel failure (TVF).
Time frame: 12 Months follow-up
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for target-vessel myocardial infarction (MI).
Time frame: 12 Months follow-up
Compare the predictive capacity of the PPG derived from pressure microcatheter versus pressure wire for ischemia-driven target-vessel revascularization (ID-TVR).
Time frame: 12 Months follow-up
Compare the predictive capacity of the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire for target-vessel myocardial infarction (MI).
Time frame: 12 Months follow-up
Compare the predictive capacity of the post-PCI residual pressure gradients from pressure microcatheter versus pressure wire for target vessel revascularization.
Time frame: 12 Months follow-up
Compare the rate of peri-procedural myocardial infarction stratified by PPG derived from pressure microcatheter versus pressure wire.
Time frame: Periprocedural timeframe
Compare the rate of peri-procedural myocardial injury stratified by PPG derived from pressure microcatheter versus pressure wire.
Time frame: Periprocedural timeframe
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Jan 2026.
- Derived from this study: PubMed 41195772Stalikas N, Mizukami T, Bouisset F, Ikeda K, Tajima A, Munhoz D, Mahendiran T, Wilgenhof A, Sakai K, Noorgard B, Engstroem T, Leipsic J, Stefanini G, Bartorelli A, Fairbairn T, Bagnall A, Ko B, Johnson NP, Berry C, Perera D, Christiansen EH, Shinke T, Otake H, Koo BK, Barbato E, Brugaletta S, Collison D, Campo G, Van Belle E, Goori T, Van Nunen L, Witkowski A, Astudillo P, Spratt J, Amano T, Ando H, Sianos G, Sonck J, Andreini D, De Bruyne B, Collet C. Vessel-Specific Myocardial Mass in Patients With Stable Coronary Artery Disease. J Am Heart Assoc. 2025 Nov 18;14(22):e039013. doi: 10.1161/JAHA.124.039013. Epub 2025 Nov 6.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Emanuele Barbato, MD, PhD principal investigator
Azienda Ospedaliera Universitaria Sant'Andrea, Roma
Carlos Collet, MD, PhD principal investigator
CoreAalst BV
Junbo Ge, MD principal investigator
Zhongshan Hospital, Fudan University, Shanghai
29 sites in 8 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Pressure Microcatheter guided strategy - PIOS MC and Pressure Wire guided strategy - PIOS - PW in people with Coronary Artery Disease and Acute Coronary Syndrome, run by CoreAalst BV at 29 sites in 8 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 12 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 29 sites in Germany, Italy, Belgium, China, France and 3 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sofie Pardaens (0032 53 72 42 30, sofiepardaens@coreaalst.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Compare the rate of MACE between pressure microcatheter and pressure wire strategies. (time frame: 12 Months follow-up). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05437900, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jan 2026.