In a significant advancement for cardiovascular medicine, the Society for Cardiovascular Angiography & Interventions (SCAI) has released a new expert opinion shedding light on the transformative potential of angiography-derived physiology (ADP) in the assessment and management of coronary artery disease (CAD). This innovation stands at the crossroads of computational modeling, artificial intelligence (AI), and standard coronary angiographic imaging, offering an unprecedented wire-free method to gauge coronary physiology. The implications of this technology promise to redefine interventional cardiology by enhancing diagnostic precision and tailoring treatment strategies with greater confidence.
The publication, featured in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI), meticulously details the clinical integration of ADP, providing guidance on its application within cardiac catheterization laboratories. The discourse elaborates on the evolving evidence base for ADP, setting a framework for its deployment in routine practice while elucidating current limitations that must be addressed through ongoing research. This confluence of technology and clinical insight is pivotal for cardiologists striving to optimize patient outcomes amidst the complexities of coronary artery disease.
Angiography-derived physiology leverages AI algorithms and computational fluid dynamics to extract physiological data directly from angiographic images. Unlike traditional methods relying on invasive pressure wire techniques, ADP offers a non-invasive, efficient pathway to assess the functional significance of coronary lesions. This approach significantly reduces procedural complexity and patient discomfort associated with pressure wire interrogation. By employing sophisticated modeling, ADP translates angiographic datasets into physiological metrics, enabling precise identification of ischemia-inducing stenoses without the need for additional instrumentation within the coronary vessels.
Despite the established dominance of pressure wire-based assessments as the gold standard for intermediate coronary lesions, their application in clinical practice remains limited, utilized in only 10 to 20 percent of cases. This underutilization stems from factors such as procedural time, cost, technical expertise requirements, and patient tolerance. ADP emerges as a compelling alternative capable of mitigating these barriers. By facilitating wire-free physiological assessments, ADP has the potential to significantly expand the accessibility and adoption of physiology-guided decision-making, which is foundational to high-quality interventional cardiology.
The SCAI expert roundtable, comprising international leaders in interventional cardiology and cardiovascular imaging, undertook a rigorous evaluation of various ADP platforms. The panel highlighted methodologic nuances distinguishing different technologies, emphasizing the need for clinicians to understand these differences to optimally harness ADP in practice. The roundtable underscored clinical scenarios where ADP offers particular promise, including the complex assessment of multivessel coronary disease, strategic planning and optimization of percutaneous coronary interventions (PCI), and the post-PCI evaluation of coronary physiology. Notably, ADP also facilitates the assessment of non-culprit lesions in acute coronary syndrome patients, potentially guiding more nuanced revascularization strategies.
It is critical to recognize that the effectiveness of ADP is contingent upon high-quality angiographic image acquisition and operator expertise. The precision of computational modeling depends fundamentally on the fidelity of input data. Thus, procedural protocols must emphasize optimal angiographic techniques—including multiple angiographic projections and reduced image artifacts—to maximize the reliability of physiological results. Furthermore, operators should be adequately trained in both the technical aspects and interpretive nuances of ADP to fully realize its clinical utility, particularly in complex cases where coronary anatomy and physiology may be challenging to characterize.
The new expert opinion delineates where ADP should be considered a complementary tool rather than a wholesale replacement for established wire-based physiology assessments. It cautions clinicians against over-reliance on ADP in scenarios where supporting evidence remains limited or where specific technical limitations might attenuate accuracy. This balanced perspective aims to foster a judicious adoption of ADP, ensuring that patients derive maximal benefit without compromising the scientific rigor underlying coronary physiology evaluation.
Encapsulating the expert discussion, William F. Fearon, MD, MSCAI, Chief of Interventional Cardiology at Stanford University School of Medicine, emphasized that physiology-guided decision-making remains an indispensable pillar of coronary intervention. Dr. Fearon articulates that ADP represents an important technological stride forward but underlines the necessity of integrating ADP into clinical workflows with conscientious awareness of its assumptions, methodological constraints, and evidentiary foundations. Such an informed approach promises to enhance clinical outcomes while promoting innovation responsiveness within interventional cardiology.
Importantly, the expert panel acknowledges that the field of angiography-derived physiology remains dynamic, with continuous refinement of computational algorithms and imaging techniques underway. The integration of AI-powered analysis and machine learning is anticipated to accelerate, driving improvements in accuracy, user-friendliness, and diagnostic yield. However, these promising developments must be matched by robust clinical outcomes research and real-world validation to verify that enhanced technological capabilities translate into tangible patient benefits.
Another critical dimension emphasized by the roundtable is the imperative for structured training programs. As ADP systems permeate clinical practice, standardized education pathways will be crucial to equip interventionalists with the necessary knowledge and skills. Such training will encompass both the technical aspects of ADP execution and the nuanced interpretation of physiological data within the broader clinical context. By fostering operator competence, the cardiology community can safeguard against misapplication and variability in ADP use.
The support of leading cardiovascular technology firms, including CathWorks and Medtronic, reflects a collaborative commitment to advancing the science and clinical implementation of ADP. This partnership underscores the synergy between industry innovation and clinical expertise crucial for translating cutting-edge technologies into everyday patient care. The involvement of these entities also facilitates the dissemination of ADP platforms, supporting broader clinical adoption and ongoing translational research.
Looking ahead, the incorporation of angiography-derived physiology into routine cardiac catheterization practice represents a paradigm shift with profound implications. By combining non-invasive, AI-driven computational analysis with the inherent anatomical insights of conventional angiography, ADP epitomizes the next frontier of personalized cardiovascular medicine. As the field evolves, this hybrid approach promises to refine the precision of coronary lesion assessment, optimize interventional strategies, and ultimately improve outcomes for patients with coronary artery disease worldwide.
As physicians assimilate the expert recommendations and integrate ADP into their diagnostic armamentarium, the balance of technological innovation and clinical prudence will be essential. This expert opinion from the Society for Cardiovascular Angiography & Interventions not only demystifies angiography-derived physiology but also catalyzes a thoughtful dialogue on its appropriate, evidence-based use. Such discourse is vital for harnessing the full potential of this transformative technology while maintaining the highest standards of patient care.
Subject of Research: People
Article Title: Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion from a SCAI Roundtable
News Publication Date: 3-Feb-2026
Web References:
https://www.jscai.org/article/S2772-9303(25)01602-3/fulltext
https://doi.org/10.1016/j.jscai.2025.104156
Keywords: Cardiology, Health and medicine, Medical specialties
