TCT-306 Angiography-Derived Physiology Versus Pressure-Wire–Based Fractional Flow Reserve for Guiding Coronary Revascularization: A Comprehensive Meta-Analysis of Six Randomized Controlled Trials With Platform-Specific Subgroup Analyses

Dr. Damien Collison

“We should still be cognizant that each step taken toward developing a completely simulated FFR assessment has required incremental compromises on accuracy and fidelity. Whatever risks that may hold for patients will only be identified and fully understood through longer-term follow-up of large, randomized trials with particular focus on the discordant cases where FFR and angiography-derived FFR disagree.”

“The broader implication is not a comparison between angiography-derived and wire-based testing but a shift away from reliance on anatomy alone. Angiography-derived FFR may serve as an integrated, first-line physiological assessment during diagnostic imaging, providing an immediate functional estimate to inform revascularization decisions.”

“We have shown that using this (FFRangio) software-based tool in the cath lab results in similar clinical outcomes at one year compared with the current gold standard of invasive wire-based assessment. Our hope is that these findings – with a technology that does not require further coronary manipulation beyond a routine angiogram – will lead to increased adoption of coronary physiologic testing as recommended by current guidelines.”