Angiography-Derived FFR: Can We Guide PCI Without a Pressure Wire? | JACC Baran

Can we make reliable PCI decisions based on coronary angiography alone? Host Mitsuaki Sawano, MD, welcomes Toru Tanigaki, MD (Gifu Heart Center), Takuya Mizukami, MD, PhD (Showa Medical University), and Hitoshi Matsuo, MD, PhD (Gifu Heart Center) to discuss their recent JACC: Cardiovascular Interventions study. The investigator-initiated PROVISION trial randomised 401 patients across 13 Japanese centres to angiography-derived FFR (FFRangio) or conventional pressure wire-based FFR. Revascularisation rates were 41.4% versus 37.9%, meeting the prespecified noninferiority criterion, with no significant difference in 1-year clinical events. We discuss whether angiography-derived FFR is ready for clinical decision-making, the challenges of conducting an independent RCT, and how computational physiology and AI could transform coronary assessment.