ACC.26 – Dr Ajay Kirtane (NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, US) discusses the ALL-RISE trial (NCT05893498), a large-scale, global, prospective, randomised, multicentre study comparing FFRangio-based, angiography-derived coronary physiology with conventional pressure wire-guided FFR/NHPR to direct PCI in patients with coronary artery disease.

This pivotal non-inferiority trial (≈1,924 patients) tests whether an FFRangio-guided strategy can match wire-based physiology for 1-year MACE while also evaluating procedure time, contrast and radiation dose, peri-procedural complications, patient-reported outcomes, usability, resource utilisation and cost-effectiveness. Optimised for contemporary cath lab practice, ALL-RISE addresses whether a wire-free, angiography-derived approach can become a new standard for physiology-guided PCI and which patients, lesions and centres are best suited to an FFRangio-first strategy. 

Findings showed similar 1-year MACE outcomes in the FFRangio arm (6.9%) compared to the conventional wire-based arm (7.1%), meeting non-inferiority. FFRangio was faster to perform, and did not require additional procedural manipulation, unlike wire-based methods.

Interview Questions:

1. What is the current role of coronary physiology in guiding PCI, and what are the limitations of the existing pressure wire-based approach?
2. What were the aims of this trial?
3. Can you walk us through the study design and patient population?
4. What were the key findings?
5. How do these results compare to previous data on angiography-derived versus invasive physiological assessment?
6. What are the clinical implications for interventional cardiologists looking to adopt angiography-derived physiology in routine practice?
7. What are the next steps for this research?

Recorded on-site at ACC.26, New Orleans.

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Editor: Jordan Rance
Videographer: Mike Knight

Support: This is an independent interview produced by Radcliffe Cardiology.