Wireless angiography‑derived physiology (ADP) has the potential to address key limitations of invasive wire‑based assessment—the gold standard for evaluating intermediate coronary stenoses—by streamlining workflow, reducing costs and procedural time, and encouraging increased adoption.

There are numerous clinical applications where ADP may be advantageous. These include assessment of multivessel disease, planning and optimization of percutaneous coronary intervention (PCI), post-PCI prognostication, and evaluation of non-culprit lesions in patients presenting with acute coronary syndromes. However, ADP has technical considerations and challenges, such as operator-dependent image quality, evidence gaps in complex lesion subsets, and systemic barriers, that limit broad adoption.

This manuscript represents considerations and consensus perspectives that emerged from a scientific roundtable discussion held on May 30, 2025, that included US-based and international leaders. This document reflects the roundtable's key insights and expert opinions on the evolving role of ADP, platform-specific evidence, optimal clinical applications, and a future directions to overcome barriers and enhance its clinical utility.

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Angiography derived physiology (ADP) is an emerging, wire free method for evaluating coronary physiology using AI enhanced analysis of routine angiographic images, offering the potential to streamline cath lab workflows.

This interview Evan Shlofmitz, William Fearon, Dean Kereiakes, and Birgitte Krogsgaard Anderson discuss highlights from the SCAI roundtable, including core concepts, clinical applications, advantages and limitations, available technologies, and future directions for integrating ADP into practice. 

All authors: Evan Shlofmitz, DO; Doosup Shin, MD, FSCAI; Mirvat Alasnag, MD, FSCAI; Karim Al-Azizi, MD, FSCAI; Ziad A. Ali, MD, DPhil; Sripal Bangalore, MD, MHA, FSCAI; Carlos Collet, MD, PhD; Javier Escaned, MD, PhD; Nieves Gonzalo, MD, PhD; Allen Jeremias, MD, MSc, FSCAI; Amir Kaki, MD, FSCAI; Morton J. Kern, MD, MSCAI; Sanjeev Patel, MD; Jennifer A. Rymer, MD, MBA, MSH; Yader Sandoval, MD, FSCAI; Devraj Sakul, MD, MSc, FSCAI; Rajiv Tayal, MD, MPH; and William F. Fearon, MD, MSCAI.