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27 Jul 2025 - 30 Jul 2025

AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

AI-Powered Imaging Technique Shows Promise in Evaluating Patients for PCI

By MedImaging International staff writers
Posted on 01 Apr 2025

Image: The AI-powered FFR assessment is comparable to conventional assessment (Photo courtesy of 123RF)

Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a minimally invasive procedure where small metal tubes called stents are inserted into partially blocked coronary arteries to help keep them open. To determine which patients are most likely to benefit from PCI, fractional flow reserve (FFR) assessment is used. This technique measures blood pressure and flow in the blocked arteries, helping identify which patients should undergo PCI and which ones can be managed with medication. Typically, patients with an FFR score of 0.80 or lower are recommended for PCI, while those with a score above 0.80 continue with medication. Traditional FFR assessment involves threading a catheter or wire through the body to assess blood flow and pressure in the coronary arteries. While effective in identifying those most likely to benefit from PCI, technical and logistical challenges have hindered the widespread use of this method. Now, researchers have found that patients with at least 50% narrowing in three major coronary arteries had similar outcomes when treated with a minimally invasive stent placement guided by either ultrasound-based imaging or a novel, artificial intelligence (AI)-powered non-invasive imaging method derived from angiography.

The FLAVOUR II study, conducted by researchers from The Second Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China), aimed to assess the effectiveness of AI-powered FFR assessment in PCI outcomes. The study met its primary endpoint, which combined death, heart attack, or the need for a repeat procedure after one year. The study enrolled patients who had angiographically significant coronary artery disease, with three of the major arteries supplying blood to the heart showing inflammation or partial blockage from cholesterol buildup. The patients experienced symptoms such as chest pain and shortness of breath. The research team used an innovative AI method called AngioFFR, which calculates FFR from a single-view angiogram (X-ray) of the coronary arteries. Unlike conventional FFR assessment, AngioFFR is non-invasive, simpler, and quicker to perform. The study aimed to compare the outcomes of patients receiving PCI guided by AngioFFR with those guided by intravascular ultrasound (IVUS), which uses sound waves to visualize the extent of arterial narrowing and is the most common imaging technique for guiding PCI.

A total of 1,872 patients (average age 65 years, 68% male) from 22 medical centers in China participated in the study. To be eligible, patients needed at least 50% narrowing in three major coronary arteries, without significant narrowing in the left main coronary artery. Many of the participants had one or more co-existing conditions, including high blood pressure (67.6%), diabetes (31%), high cholesterol (66.9%), chronic kidney disease (24.3%), smoking (25%), and previous heart attack (13.9%). Participants were randomly assigned to undergo either AngioFFR-guided or IVUS-guided PCI. In the AngioFFR group, PCI was performed if the AngioFFR score was 0.80 or lower. In the IVUS group, PCI was carried out if the narrowest part of the artery was between three and four millimeters in width, and the plaque burden (the amount of plaque in the most severely narrowed part of the artery) was above 70%.

At the one-year follow-up, 73.9% of patients in the AngioFFR group received PCI, compared to 83.1% in the IVUS group. The rate of composite outcomes, including death, heart attack, or the need for a repeat procedure, was 6.3% in the AngioFFR group and 6.0% in the IVUS group, with no significant statistical difference. The clinical outcomes of both groups in terms of death, heart attack, and the need for a repeat procedure were similar. The researchers also observed no significant differences between the groups in subgroups such as patients with diabetes. The team plans to continue following the study participants for at least five years to assess any long-term differences in effectiveness between the two methods. The results were presented at the American College of Cardiology’s Annual Scientific Session (ACC.25) and published simultaneously online in The Lancet. However, the researchers acknowledged the study's limitations, including the lack of complex lesions among participants, which are more challenging to treat with PCI, and the lack of diversity in the patient population, as the study was conducted in China.

“This is the first such study to be conducted in patients with angiographically significant lesions,” said Jian’an Wang, MD, a professor in the Heart Center at The Second Affiliated Hospital of Zhejiang University School of Medicine, and the study’s senior author. “Patients whose evaluation was non-invasively guided by the novel, AI-powered technique underwent approximately 10% fewer procedures, and their outcomes were comparable with those for patients whose evaluation was guided by a commonly used ultrasound-based imaging technique.”

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74 (61.03515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804502 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (43.869018554688): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

76 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (85.830688476562): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

91 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

92 (70.810317993164): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294804502 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

94 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

95 (387.19177246094): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294804502 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (786.06605529785): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (509.97734069824): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

99 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

100 (129.93812561035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

101 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

102 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

103 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

104 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

105 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

106 (211.95411682129): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

107 (!!!!! 29634.952545166): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

108 (641.1075592041): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804502 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294804502 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 10017.871856689): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (125.88500976562): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (335.9317779541): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

112 (79.870223999023): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

113 (200.98686218262): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

114 (66.041946411133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

115 (161.88621520996): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

116 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

117 (160.93254089355): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

118 (86.069107055664): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

119 (365.01884460449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

120 (158.07151794434): SELECT name FROM jos_deeppockets WHERE id=211

121 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=211

122 (791.07284545898): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

123 (761.98577880859): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

124 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

125 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

126 (!!!!! 5939.0068054199): TRUNCATE TABLE jos_trademed_module

127 (164.98565673828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294804502 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

128 (665.90309143066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

129 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

130 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

131 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

132 (!!!!! 1278.8772583008): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

133 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

134 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

135 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294804502 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294804502 AND type='deeppockets_item' AND published='1' LIMIT 1

136 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

137 (37.908554077148): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

138 (36.954879760742): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

139 (329.97131347656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

140 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294804502 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294804502 AND published='1' LIMIT 1

141 (119.92454528809): select jos_twitters.link from jos_twitters where cat=10

142 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

143 (28.133392333984): select jos_google_plus.link from jos_google_plus where cat=10

144 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

145 (259.8762512207): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

146 (!!!!! 1006.8416595459): insert into jos_banners_delta values (14615,'2025-06-21 00:31:02','216.73.216.120','view'),(14202,'2025-06-21 00:31:02','216.73.216.120','view'),(14203,'2025-06-21 00:31:02','216.73.216.120','view')

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