Angiography-Derived Fractional Flow Reserve to Guide PCI.

Summary

In 1930 patients with intermediate coronary stenoses, angiography-derived FFR (FFRangio) was noninferior to pressure-wire–based FFR at 1 year for death, MI, or unplanned revascularization, with similar safety. This supports wire-free physiology to guide PCI without compromising outcomes.

Key Findings

• FFRangio was noninferior to pressure-wire FFR for 1-year composite of death, MI, or unplanned revascularization.
• No differences in bleeding, acute kidney injury, or procedural adverse events between strategies.
• Randomized, international noninferiority design with 1930 patients supports wire-free physiology.

Clinical Implications

Catheterization laboratories can streamline procedures and avoid hyperemia/pressure wires by adopting validated angiography-derived FFR, provided image quality and workflow are optimized and teams are trained.

Limitations

• Open-label design; performance may depend on angiographic image quality and operator workflow
• Follow-up limited to 1 year; longer-term outcomes and cost-effectiveness pending

Future Directions

Implementation studies on workflow integration, site training, cost-effectiveness, and head-to-head comparisons among different angiography-derived physiology algorithms.