{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:14:32Z","timestamp":1783692872659,"version":"3.55.0"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JRSM Cardiovascular Disease"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20131.54;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.37;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200957%), all-cause mortality (RR: 1.08, 95% CI: 0.75\u20131.56;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.68), cardiac death (RR: 0.89, 95% CI: 0.53\u20131.49;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.66), and any myocardial infarction (RR: 1.14, 95% CI: 0.66\u20131.98;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.64) between ADP-guided and pressure-wire\u2013based FFR-guided strategies. Clinically indicated revascularization was significantly higher with ADP (RR: 1.12, 95% CI: 1.05\u20131.20;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.005;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Trial sequential analysis confirmed that the accumulated evidence was sufficient to conclude no clinically meaningful difference in composite outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ADP-guided revascularization achieves broadly comparable clinical outcomes to pressure-wire\u2013based 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20480040261469414","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:26:31Z","timestamp":1783689991000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Angiography-derived physiology versus pressure wire-based fractional flow reserve for coronary revascularization guidance: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2265-3798","authenticated-orcid":false,"given":"Mokshit Mehul","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Medicine, GMERS Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarosh","family":"Fatima","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dow Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Khachatryan","sequence":"additional","affiliation":[{"name":"Fanarjyan Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7151-8479","authenticated-orcid":false,"given":"Igwilo Chukwudumebi","family":"Angela","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Lagos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umair","family":"Arshad","sequence":"additional","affiliation":[{"name":"Department of Medicine, Services Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0154-8697","authenticated-orcid":false,"given":"Jahnoy","family":"St. Jacques","sequence":"additional","affiliation":[{"name":"University of the West Indies"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6398-8378","authenticated-orcid":false,"given":"Naima","family":"Agha","sequence":"additional","affiliation":[{"name":"Department of Medicine, Foundation University Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1445-9522","authenticated-orcid":false,"given":"Hamza","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Aga Khan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bigenimana Adimirabilis","family":"Malombe","sequence":"additional","affiliation":[{"name":"Department of Pathology, Catholic University of Health and Allied Science (CUHAS)-Bugando"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Ayaz","sequence":"additional","affiliation":[{"name":"Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4048-0316","authenticated-orcid":false,"given":"Mirza Muhammad Hadeed","family":"Khawar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Services Institute of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7051-7413","authenticated-orcid":false,"given":"Muneeb","family":"Khawar","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001209"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907272"},{"key":"e_1_3_3_4_2","first-page":"1492","article-title":"The Continuum of invasive techniques for the assessment of intermediate coronary lesions","volume":"12","author":"Popa-Fotea NM","year":"2022","unstructured":"Popa-Fotea NM, Scafa-Udriste A, Dorobantu M. The Continuum of invasive techniques for the assessment of intermediate coronary lesions. Diagnostics (Basel, Switzerland) 2022; 12: 1492.","journal-title":"Diagnostics (Basel, Switzerland)"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-020-0803-7"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.15420\/ecr.2018:7:2"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae177"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad286"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.02.008"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.04.037"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-022-01687-4"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009603"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.035"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02175-5"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2600949"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2601841"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_3_18_2","article-title":"Rob 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al. Rob 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clinical Research Ed.) 2019; 366: l4898.","journal-title":"BMJ (Clinical Research Ed.)"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_3_3_21_2","first-page":"693","article-title":"Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: an individual patient-data meta-analysis","volume":"94","author":"Westra J","year":"2019","unstructured":"Westra J, Tu S, Campo G, et al. Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: an individual patient-data meta-analysis. Catheter Cardiovasc Interv 2019; 94: 693\u2013701.","journal-title":"Catheter Cardiovasc Interv"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011605"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.21037\/cdt-20-226"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-00988"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1205361"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1616540"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2024.3314"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.028423"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0807611"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14175946"},{"key":"e_1_3_3_31_2","first-page":"104156","article-title":"Angiography-derived physiology for coronary artery disease assessment: expert opinion from a SCAI roundtable","volume":"5","author":"Shlofmitz E","year":"2026","unstructured":"Shlofmitz E, Shin D, Alasnag M, et al. Angiography-derived physiology for coronary artery disease assessment: expert opinion from a SCAI roundtable. J Soc Cardiovasc Angiogr Interven 2026; 5: 104156.","journal-title":"J Soc Cardiovasc Angiogr Interven"}],"container-title":["JRSM Cardiovascular Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20480040261469414","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20480040261469414","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20480040261469414","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:26:33Z","timestamp":1783689993000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20480040261469414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":30,"alternative-id":["10.1177\/20480040261469414"],"URL":"https:\/\/doi.org\/10.1177\/20480040261469414","relation":{},"ISSN":["2048-0040","2048-0040"],"issn-type":[{"value":"2048-0040","type":"print"},{"value":"2048-0040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"article-number":"20480040261469414"}}