Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Four specialists contributed to this briefing. Three had used Optowire.

Level of innovation

One specialist felt Optowire is a minor variation to pressure wires already used widely in the NHS. Another specialist referred to it as a fine tuning on existing pressure wires. Two specialists thought that the main innovation is that Optowire is fibreoptic. They noted that the technology has been superseded by pressure wires to measure non-hyperaemic indices (such as instantaneous wave-free ratio and diastolic pressure ratio) alone or as well as fractional flow reserve (FFR). One specialist noted that more established pressure wires (St Jude and Volcano) have greater functionality. Fibreoptic wires could have advantages including kink resistance, ease of delivery and less data drift. However, 2 specialists noted that in clinical practice, Optowire has no observable advantage over other pressure wires. Another specialist stated that the device reduced drift and increases test accuracy. Two specialists noted Boston Scientific's Comet as a comparator. Another specialist identified a fibreoptic pressure catheter: Acist-Navvus.

Potential patient impact

One specialist noted that the ease of use of the device could benefit the patient, particularly if reconnection to the measuring system is needed after a prolonged procedure. Another specialist felt patients will benefit from reduced procedure times, reduced contrast and radiation exposure. People with complex coronary arteries and people with cardiac symptoms who have been invited to have an angiogram are likely to benefit from the technology. All specialists agreed that the technology would not change the current clinical pathway.

Potential system impact

Three specialists thought the technology has little potential benefit to the healthcare system. One specialist noted that improved FFR accuracy and reduced procedure times would benefit the healthcare system. Three specialists agreed that there would be little or no resource impact if the technology was adopted. One specialist thought the higher price of the device compared with other pressure wires would have a sizable financial impact. In this specialist's opinion, the higher cost of the wire is not justifiable.

General comments

One specialist highlighted the need for comparative evidence that shows the claimed benefit and long-term impact of the device. Two specialists had stopped using the device because they found it had some drift. One of them felt it was less accurate than other wires. Two specialists stated that non-hyperaemic indices that do not need to widen the blood vessels are now supported by good data with clinical endpoints, and that these are now used routinely. Another specialist noted that drift can be corrected by an experienced clinician.