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Angiography-Derived Fractional Flow Reserve to Guide PCI.

William F Fearon1,2, Allen Jeremias3,4, Guy Witberg5,6

  • 1Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, CA.

The New England Journal of Medicine
|March 30, 2026
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Summary
This summary is machine-generated.

Angiography-derived fractional flow reserve (FFRangio) is a noninferior alternative to pressure wire measurements for assessing intermediate coronary lesions. This simplified approach showed comparable clinical outcomes in patients undergoing cardiac catheterization.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Intracoronary pressure wire assessment of intermediate coronary lesions improves outcomes but sees limited clinical use.
  • Fractional flow reserve (FFR) derived from coronary angiography (FFRangio) correlates with pressure-wire FFR and may simplify procedures.
  • The clinical impact of FFRangio on patient outcomes remained unknown prior to this study.

Purpose of the Study:

  • To determine if an angiography-guided strategy using FFRangio is noninferior to a pressure-wire-guided strategy for patients with intermediate coronary lesions.
  • To compare the composite endpoint of death, myocardial infarction, or unplanned revascularization at 1 year between the two assessment methods.

Main Methods:

  • An international noninferiority trial randomly assigned 1930 patients with intermediate coronary stenosis to either FFRangio or pressure-wire-based physiological assessment.
  • The primary endpoint was a composite of death, myocardial infarction, or unplanned, clinically indicated coronary revascularization at 1 year.
  • The noninferiority margin was set at 3.5 percentage points.

Main Results:

  • At 1 year, the primary endpoint occurred in 6.9% of the FFRangio group and 7.1% of the pressure-wire group (HR, 0.98; 95% CI, 0.70 to 1.39).
  • FFRangio was found to be noninferior to the pressure-wire approach, with a difference of -0.2 percentage points (P<0.001 for noninferiority).
  • No significant differences were observed in bleeding, acute kidney injury, or procedure-related adverse events between the groups.

Conclusions:

  • An angiography-guided strategy using FFRangio is noninferior to a pressure-wire-guided strategy for physiological assessment of intermediate coronary artery lesions.
  • FFRangio offers a simplified approach to assessing coronary lesions, providing comparable clinical outcomes to traditional pressure-wire methods.
  • This study supports the use of FFRangio in routine cardiac catheterization procedures for intermediate coronary lesions.