Distributor Highlight – Al Umnia 

The final quarter of 2020 was an exciting time for ACIST in Europe as we unveiled our new long-awaited non-hyperemic index dPR– our adenosine-free predictor of ischemia – which now sits alongside Pd/Pa and FFR on our RXI consoles. We’re receiving great feedback from European customers who have started to use dPR, which is in line with the experience of the one distributor who already had dPR for over a year – Al Umnia, our partner in the United Arab Emirates (UAE).

Al Umnia launched RXI and Navvus in 2016 and quickly established the technology. Thanks to a great deal of hard work from their two FFR experts, Ashok Murugesan and Davis Chittilappilly, and the expert guidance of Director Rami Abusamra, they placed 18 systems in the first two years in UAE’s 28 cath labs, and quickly took a sizeable share of the crowded UAE physiology market. Ashok estimates that the 320 Navvus used in 2019 amounted to 35% of the market.

Building on that success, and as dPR did not require CE mark or FDA approval in UAE,  we were able to launch in June 2019. As we know, the background is that a significant number of physicians remain true-believers in FFR, but iFR has made inroads into the market in recent years, with many physicians persuaded to preference the greater ease and speed of the non-hyperemic indices over the superior diagnostic accuracy of FFR. Faced with this reality, Al Umnia carefully identified the 10 centres where interest in adenosine-free indices was greatest and upgraded those consoles.

One year on, we can see that despite the lack of prospective dPR data, the well-established class-effect of the non-hyperemic indices has meant that ACIST dPR has been rapidly adopted by physicians on both sides of the hyperemia divide in UAE, whichever way they lean. ACIST dPR allows physicians to assess ischemia in the quickest possible way, while enjoying the proven benefits of our rapid-exchange Navvus microcatheter. Minimal training is required for new users. After equalization, Navvus slides into position on the guidewire and at the touch of a single button, the console instantly gives you the dPR value.

 In the literature, the established cut-off of for dPR is 0.89 but Ashok reports that most UAE physicians are using a  “hybrid”  approach and opting for FFR if the dPR result is in the 0.88-0.92 range.  In terms of case numbers, Al Umnia report, in the 17 months since the launch, 115 dPR-only cases in which the clinical decision was made without FFR. They have also done a further 265 cases in which both dPR and FFR were measured, either due to a dPR value close to the cut-off, or because of the physician’s preference for FFR. These numbers show that even when they intend to proceed to FFR, it takes hardly any time for a physician to add a dPR value to aid the assessment of lesion severity and ischemia. In the last month or two, the whole procedure has now been made even more seamless with Navvus II.

Feedback in UAE has generally been excellent – physicians appreciate the quick and easy one-touch measurement and instant calculation without the added inconvenience and cost of adenosine. Our unique BeatCheck™ feature is also winning plaudits. According to Ashok, physicians feel that BeatCheck™ “gives complete confidence” regarding the accuracy of the measurement. If there is any doubt, the measurement can be repeated in a matter of seconds.

You can watch Rami Abusamra and Ashok Murugesan talk about their experience in this video: Al Umnia – Video

Finally, a word of congratulations to Al Umnia for their success in launching dPR and their continued commitment to the ACIST product portfolio. We look forward to hearing more positive feedback and more success stories as more of our distributor partners launch dPR in their respective markets.

Mark Green

Business Manager – EMEAI