Abstract
Background
Pressure-wire-based fractional flow reserve (FFR) is the gold standard for physiological assessment of intermediate coronary stenoses but remains underutilized owing to procedural complexity, cost, and the need for hyperemic agents. Angiography-derived physiology (ADP) platforms offer a wire-free, adenosine-free alternative. This systematic review and meta-analysis compared the clinical outcomes of ADP-guided versus FFR-guided revascularization in patients with coronary artery disease.
Methods
Comprehensive searches were performed in PubMed, Embase, ScienceDirect, and Cochrane CENTRAL from inception to April 2026. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals using random-effects models and robustness was checked with trial sequential analysis (TSA).
Results
Three multicenter randomized controlled trials involving 6165 patients were included. There was no significant difference in the primary composite endpoint (RR: 1.14, 95% CI: 0.85–1.54; p = 0.37; I2 = 57%), all-cause mortality (RR: 1.08, 95% CI: 0.75–1.56; p = .68), cardiac death (RR: 0.89, 95% CI: 0.53–1.49; p = .66), and any myocardial infarction (RR: 1.14, 95% CI: 0.66–1.98; p = .64) between ADP-guided and pressure-wire–based FFR-guided strategies. Clinically indicated revascularization was significantly higher with ADP (RR: 1.12, 95% CI: 1.05–1.20; p = .005; I2 = 0%). Trial sequential analysis confirmed that the accumulated evidence was sufficient to conclude no clinically meaningful difference in composite outcome.
Conclusion
ADP-guided revascularization achieves broadly comparable clinical outcomes to pressure-wire–based FFR. Although ADP offers procedural advantages, certain platforms were associated with modestly higher revascularization rates. These findings support ADP as a practical alternative to conventional FFR in selected patients.
This is a visual representation of the abstract.
Keywords
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
