SCAI Expert Opinion Explores Angiography-Derived Physiology for Coronary Assessment

February 5, 2026—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the publication of an expert opinion document that examines the evolving role of angiography-derived physiology (ADP) for the assessment and management of coronary artery disease. SCAI noted that the wire-free method for coronary physiologic assessment applies computational modeling or artificial intelligence (AI) to standard coronary angiographic images.

According to the society, the expert opinion from an SCAI roundtable provides practical guidance on when and how ADP may be used in clinical practice, what questions it can help answer in the cardiac catheterization laboratory, and where important limitations remain.

As summarized in the press release, the international panel reviewed available ADP platforms, highlighted key methodological differences, and defined clinical scenarios where the technology may be most useful—including assessment of multivessel disease, planning and optimization of percutaneous coronary intervention (PCI), post-PCI physiologic evaluation, and evaluation of nonculprit lesions in patients presenting with acute coronary syndromes.

The document emphasized the importance of high-quality angiographic acquisition and appropriate operator expertise, particularly in complex clinical settings, noted SCAI.

The document was published by the roundtable chair Evan Shlofmitz, DO, et al in JSCAI. The expert roundtable was conducted with support from CathWorks and Medtronic, noted the SCAI press release.

“Physiological assessment using pressure wires remains the gold standard for evaluating intermediate coronary lesions, yet utilization is only 10-20%,” commented Dr. Shlofmitz in the SCAI press release. “ADP has the potential to address many of these barriers.”

Dr. Shlofmitz continued, “The use of ADP has advanced quickly, and many interventionalists are encountering these tools without a clear framework for interpretation or application. Our goal was to rigorously evaluate the evidence, define where ADP offers meaningful clinical value today, and clearly articulate the limitations and unanswered questions that must be addressed before broader adoption.”

William F. Fearon, MD, a coauthor of the roundtable document, added, “Physiology-guided decision-making remains foundational to high-quality coronary intervention, and ADP represents an important technological advance. At the same time, ADP must be applied with a clear understanding of its assumptions, technical requirements, and the strength of the supporting evidence. This expert opinion helps clinicians understand where ADP can responsibly complement wire-based physiology today and where caution and further data remain necessary.”