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Angiography-Derived Fractional Flow Reserve During Percutaneous Coronary Intervention.
Chieh Yang Christopher Koo1,2, Siling Li1, Rasha Al-Lamee3
1Richard A. and Susan F. Smith Center for Outcomes Research, Boston, MA (C.Y.C.K., S.L., R.W.Y., E.A.S.).
Circulation. Cardiovascular Interventions
|March 7, 2026
Summary
Angiography-derived fractional flow reserve (Angio-FFR) use is increasing in the US. This study found Angio-FFR guidance during percutaneous coronary intervention (PCI) had similar major adverse cardiovascular event rates compared to pressure wire assessment over two years.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Angiography-derived fractional flow reserve (Angio-FFR) is an emerging tool for guiding percutaneous coronary intervention (PCI).
- Current data on Angio-FFR adoption and patient outcomes compared to pressure wire (PW)-based assessment in the U.S. are limited.
Purpose of the Study:
- To evaluate the uptake of Angio-FFR in the U.S. Medicare population.
- To compare the clinical outcomes of Angio-FFR versus PW-based assessment in patients undergoing PCI.
Main Methods:
- A cohort study using U.S. Medicare data from 2019-2024.
- Propensity score matching (1:3) comparing Angio-FFR to PW in PCI and non-PCI patients.
- Primary outcome: Major adverse cardiovascular events (MACE) at 2 years. Secondary outcomes included MACE components, acute kidney injury, and bleeding.
Main Results:
- Angio-FFR use increased from 0.47% in 2019 to 3.85% in 2024.
- In PCI patients, Angio-FFR and PW groups showed similar 2-year MACE rates (24.8% vs 23.5%).
- Similar MACE rates were observed in non-PCI patients (24.1% vs 23.9%).
Conclusions:
- Angio-FFR utilization in the U.S. is currently modest but shows an upward trend.
- Angio-FFR guidance during angiography is associated with comparable 2-year clinical outcomes to PW assessment.
