Can Angiography-Guided Physiology Assessment Improve PCI Outcomes?

When cardiac catheterization reveals coronary artery disease, a key clinical question is whether the disease is flow-limiting and warrants revascularization. The current standard assessment method — advancing a pressure wire across the lesion to directly measure fractional flow reserve — improves outcomes and is guideline-recommended, yet it remains underused due to added procedural time and complexity (Figure 1). Angiography-guided physiological assessment offers a less-invasive alternative by deriving flow estimates from images acquired during the diagnostic procedure, though prior studies show mixed results. Two recent trials provide new data.

In the industry-funded ALL-RISE and FAST III trials, investigators randomized 4000 patien…