Exploring ‘wire-free’ angiography-derived physiology for coronary assessment

A new expert opinion from the Society for Cardiovascular Angiography & Interventions (SCAI) examines the evolving role of angiography-derived physiology (ADP), a wire-free method for coronary physiologic assessment that applies computational modeling or artificial intelligence (AI) to standard coronary angiographic images for the assessment and management of coronary artery disease.

Published in JSCAI, “Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion from a SCAI Roundtable” provides practical guidance on when and how ADP may be used in clinical practice, what questions it can help answer in the cardiac catheterization laboratory, and where important limitations remain.

“Physiological assessment using pressure wires remains the gold standard for evaluating intermediate coronary lesions, yet utilization is only 10–20%,” said Evan Shlofmitz, DO, Director of Intravascular Imaging at St. Francis Hospital in Roslyn, NY, and chair of the roundtable.

“The use of ADP has advanced quickly, and many interventionalists are encountering these tools without a clear framework for interpretation or application. Our goal was to rigorously evaluate the evidence, define where ADP offers meaningful clinical value today, and clearly articulate the limitations and unanswered questions that must be addressed before broader adoption.”

The expert roundtable brought together an international panel to review available ADP platforms, highlight key methodological differences, and define clinical scenarios where the technology may be most useful.

These include assessment of multivessel disease, planning and optimization of percutaneous coronary intervention (PCI), post-PCI physiologic evaluation, and evaluation of non-culprit lesions in patients presenting with acute coronary syndromes. The document emphasizes the importance of high-quality angiographic acquisition and appropriate operator expertise, particularly in complex clinical settings.

“Physiology-guided decision-making remains foundational to high-quality coronary intervention, and ADP represents an important technological advance,” said William F. Fearon, MD, MSCAI, Chief of Interventional Cardiology at Stanford University School of Medicine and the VA Palo Alto Health Care System.

“At the same time, ADP must be applied with a clear understanding of its assumptions, technical requirements, and the strength of the supporting evidence. This expert opinion helps clinicians understand where ADP can responsibly complement wire-based physiology today and where caution and further data remain necessary.”

As the technology continues to evolve, the panel underscored the importance of continued technological refinement, careful clinical application, appropriate training, and ongoing outcomes research to ensure successful integration into routine clinical practice.