Non-obstructive Coronary DiseaseAcute or Chronic Coronary Artery Disease
Investigational drug(s) / intervention(s)
Patients with intermediate coronary artery stenosis with clinically indicated FFR assessment.Microvascular assessment
Patients with intermediate coronary artery stenosis with clinically indicated FFR assessment.: Cohort 1. Patients with intermediate coronary artery stenosis (30-90% diameter stenosis) with clinically indicated FFR assessment.
Microvascular assessment: Cohort 2: Patients with non-obstructive (\<30% stenosis) disease will undergo assessment of the microcirculation with bolus and continuous thermodilution.
Study summary
The aim of this study is to establish the diagnostic performance of the AngioAI+ System (AngioInsight, Inc, USA) for estimating:
1. Fractional flow reserve (FFR) and
2. Detection of coronary microvascular disease (CMD)
SMARTFLOW is a prospective, single-arm, observational multicenter study of patients with suspected coronary artery disease (CAD) undergoing clinically indicated invasive coronary angiography with physiological assessment. The study is designed to prospectively enroll patient cohorts and collect data according to their reference procedures (e.g. FFR, CFR measures). A core lab will evaluate performance of the AngioAI+ software retrospectively using the collected SMARTFLOW study data. As such, the investigational AngioAI+ device will not inform clinical decisions amid the study procedure.
Eligibility
Sex
ALL
Min age
18 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* Patients with acute or chronic coronary syndromes referred for invasive coronary angiography with clinically indicated coronary physiologic assessment. In patients with acute coronary syndromes, the physiological evaluation will be restricted to non-culprit vessels.
* Patients with intermediate CAD (30-90% visual stenosis) with clinically indicated FFR assessment.
* Patients with NOCAD (\<30% visual stenosis) with clinically indicated microvascular assessment.
Exclusion Criteria:
* Patients presenting with ST-elevation
* Prior myocardial infarction in the target vessel
* Stent implantation in the target vessel within the last 12 months
* Previous coronary artery bypass grafting surgery (CABG)
* Previous heart valve surgery
* Previous heart transplantation
* Moderate-to-severe valvular disease
* Left ventricular ejection fraction (EF) ≤45%
* Hemodynamic instability or cardiogenic shock
Angiographic Exclusion Criteria
* Left main stenosis≥50%
* Chronic total occlusion in the target vessel
* CTO in a non-target vessel
* Less than thrombolysis in myocardial infarction (TIMI) 3 flow in the target vessel
* Target vessel receiving collaterals
* Inadequate coronary angiographic images
* Ostial lesions
* Severe tortuosity
Primary outcome measure(s)
To establish the diagnostic performance of the AngioAI+ System — June 2026 to December 2027 1\. Per-vessel diagnostic performance (i.e., sensitivity and specificity) of AngioAI+ FFR for identifying flow-limiting lesions, using measured FFR as the reference standard.
To establish the diagnostic performance of AngioAI+ System — June 2026 to December 2027 Description: 2. Diagnostic performance (i.e., sensitivity and specificity) of AngioAI+ for detecting CMD in patients with non-obstructive CAD using invasive coronary flow reserve (CFR) derived from continuous thermodilution as reference.
Trial sites (9)
Facility
City
Region
Status
Palo Alto Veterans Administration Hospital
Palo Alto
California
Stanford University
Palo Alto
California
Washington Hospital Center
Washington D.C.
District of Columbia
Minneapolis Heart
Minneapolis
Minnesota
Valley Health System
Paramus
New Jersey
New York University
New York
New York
Northwell Health
New York
New York
Christ Hospital
Cincinnati
Ohio
Ascension Saint Thomas
Nashville
Tennessee
Official registry record
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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