Impact for Treatment Decision-Making and Clinical Outcome of Angiography-Derived Fractional Flow Reserve.

Authors

Toru Tanigaki, Takuya Mizukami, Taito Arai, Kenichi Hagiya, Yuetsu Kikuta, Takanori Yoshida, Hirosada Yamamoto, Motoyoshi Takahara, Koji Isodono, Yoshiaki Kawase, Munenori Okubo, Kan Zen, Yutaka Hikichi, Noriyuki Kinoshita, Ryoji Kitamura, Takayuki Ogawa, Ken Kozuma, Mamoru Nanasato, Junya Ako, Hiromasa Otake, Hiroyoshi Yokoi, Hitoshi Matsuo

Published in

JACC. Cardiovascular interventions. Volume 19. Issue 15. Pages 2116-2126. Aug 10, 2026.

Abstract

Pressure wire-based fractional flow reserve (FFR) is the reference standard for physiologic lesion assessment but remains underutilized owing to the need for hyperemia, procedural complexity, and wire-related risks. Angiography-derived FFR provides a wire- and hyperemia-free assessment derived from routine angiography; however, its clinical impact in guiding treatment remains uncertain.
This study aimed to determine whether angiography-derived FFR is noninferior to pressure wire-based FFR in guiding revascularization decisions among patients with stable coronary artery disease.
PROVISION (Prospective randomized trial of clinical outcomes of angiography-based fractional flow reserve guidance versus wire-based fractional flow reserve guidance) was a prospective, multicenter, randomized study. Participants were randomized 1:1 to angiography-derived FFR-guided or pressure wire-based FFR-guided revascularization. The primary endpoint was the noninferiority of angiography-derived FFR in terms of revascularization rate, defined as the proportion of patients undergoing percutaneous coronary intervention or coronary artery bypass grafting based on physiologic assessment. Secondary endpoints included the 1-year incidence of major adverse cardiac events (cardiac death, any myocardial infarction, or ischemia-driven target vessel revascularization).
Overall, 401 patients (483 vessels) were enrolled at 13 Japanese centers. Revascularization was performed in 41.4% of patients in the angiography-derived FFR group and 37.9% in the pressure wire-based FFR group (absolute difference: 3.5%; 95% CI: -6.0 to 13.1; P for noninferiority = 0.049). At 1 year, major adverse cardiovascular events occurred in 8.4% and 10.1% of patients, respectively (HR: 0.84; 95% CI: 0.44-1.60; P = 0.591).
Angiography-derived FFR-guided revascularization was noninferior to pressure wire-based FFR-guided strategy for determining revascularization in patients with stable coronary artery disease. This finding suggests that angiography-derived FFR may serve as a practical, wire-free alternative for physiologic guidance of coronary revascularization, warranting confirmation in larger outcome-driven trials. (PROVISION; UMIN000049230).

PMID:
42575581
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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