Clinical Conversation in Interventional Cardiology: Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion from a SCAI Roundtable-Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion From a SCAI Roundtable

Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion From a SCAI Roundtable

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Video Summary

In a J-Sky journal panel discussion, experts including Dean Kiriakis, Evan Schlotman, William Fearon, and Bridget Anderson evaluate angiography-derived physiology (ADP) for assessing coronary artery disease. ADP enables wire-free, drug-free evaluation of coronary flow, potentially revolutionizing cath lab workflows by overcoming issues limiting traditional pressure wire techniques. Advantages include no need for anticoagulation, guide catheters, or hyperemia, shorter procedure time, lower cost, and applicability in complex cases like acute coronary syndrome and multivessel disease. The technology aids in identifying focal vs. diffuse disease, lesion-specific ischemia, and virtual stenting strategies pre-PCI, enhancing decision-making and procedure optimization.<br /><br />Three major commercially available systems exist—Cathworks, Pi, and Metis—with Cathworks uniquely offering multivessel FFR and virtual pullback for serial lesions. QFR (Quantitative Flow Ratio) uses fewer angiographic views and no aortic pressure input, allowing easier, retrospective use but showing reproducibility concerns in real-world settings. AI integration is improving user experience and variability reduction. Limitations include image quality dependency, exclusion of some complex lesions (e.g., aorto-ostial stenoses), and need for more robust large-scale randomized data.<br /><br />Current adoption in the U.S. is growing but variable; integration and training are vital for widespread use. The upcoming ALL-RAISE trial of 2,000 patients is highly anticipated to clarify ADP’s clinical utility. The panel emphasizes that ADP enhances physiology use, guides better PCI decisions, and demands continued evidence generation before full clinical adoption.

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Keywords

angiography-derived physiology

coronary artery disease

wire-free evaluation

fractional flow reserve

virtual stenting

AI integration in cardiology

ALL-RAISE trial