Integrated Pipeline for Coronary Angiography With Automated Lesion Profiling, Virtual Stenting, and 100-Vessel FFR Validation

Coronary angiography is the main tool for assessing coronary artery disease, but visual grading of stenosis is variable and only moderately related to ischaemia. Wire based fractional flow reserve (FFR) improves lesion selection but is not used systematically. Angiography derived indices such as quantitative flow ratio (QFR) offer wire free physiology, yet many tools are workflow intensive and separate from automated anatomy analysis and virtual PCI planning. We developed AngioAI-QFR, an end to end angiography only pipeline combining deep learning stenosis detection, lumen segmentation, centreline and diameter extraction, per millimetre Relative Flow Capacity profiling, and virtual stenting with automatic recomputation of angiography derived QFR. The system was evaluated in 100 consecutive vessels with invasive FFR as reference. Primary endpoints were agreement with FFR (correlation, mean absolute error) and diagnostic performance for FFR <= 0.80. On held out frames, stenosis detection achieved precision 0.97 and lumen segmentation Dice 0.78. Across 100 vessels, AngioAI-QFR correlated strongly with FFR (r = 0.89, MAE 0.045). The AUC for detecting FFR <= 0.80 was 0.93, with sensitivity 0.88 and specificity 0.86. The pipeline completed fully automatically in 93 percent of vessels, with median time to result 41 s. RFC profiling distinguished focal from diffuse capacity loss, and virtual stenting predicted larger QFR gain in focal than in diffuse disease. AngioAI-QFR provides a practical, near real time pipeline that unifies computer vision, functional profiling, and virtual PCI with automated angiography derived physiology.