Background: The clinical value of physiological assessment after percutaneous coronary intervention (PCI) remains uncertain. We evaluated clinical outcomes associated with post-PCI physiology and temporal trends in its adoption. Methods: PROPHET-FFR (NCT05056662) is an ambispective observational study of patients undergoing invasive physiological assessment of intermediate coronary stenoses. Patients were categorized into three strategies: deferred revascularization based on non-ischemic physiology (deferred PCI), PCI for ischemic lesions without post-PCI physiological assessment (conventional PCI), and physiology-guided PCI with post-PCI assessment and optimization when indicated (post-PCI physiology). Temporal trends in the use of post-PCI physiology and physiology-guided optimization were evaluated, together with the incidence of 12-month major adverse cardiovascular events (MACE), comprising cardiovascular death, spontaneous myocardial infarction, and target-vessel revascularization (TVR). Propensity score matching between conventional PCI and post-PCI physiology was performed to confirm the primary findings. Results: Among 1,986 patients, 1,307 underwent deferred PCI, 331 conventional PCI, and 348 post-PCI physiology. At 12 months, MACE occurred in 4.1%, 7.6%, and 3.4%, respectively (p=0.011). Compared with conventional-PCI, post-PCI physiology had lower MACE (3.4% vs 7.6%; p=0.019), primarily driven by reduced TVR (2.6% vs 5.4%; p=0.057), with consistent findings after propensity score matching (226 patients/group; 2.7% vs 8.0%; p=0.0114). Post-PCI physiology increased from 11.8% to 22.8% across registry phases (p<0.001), with a numerical increase in physiology-guided optimization (11.6% vs 18.1%; p=0.08). Conclusions: In this observational study, post-PCI physiology appears to be associated with lower 12-month MACE compared with conventional PCI, with consistent findings after propensity score matching.

Antiplatelet therapy is a cornerstone of care for patients with acute coronary syndrome and chronic coronary disease, yet its optimal use requires careful balancing of thrombotic risk reduction with bleeding complications. Since the mid-2000s, advances in stent technology, antiplatelet pharmacotherapy, procedural technique, and risk stratification tools have led to increasingly individualized approaches to antiplatelet management. Current guidelines and evidence emphasize tailoring agent selection, intensity, and duration of therapy according to patient-, procedure-, and disease-specific factors rather than a uniform strategy. However, the growing complexity of evidence, frequent care transitions, social determinants of health, and variability in patient characteristics have increased the risk of inappropriate prescribing, nonadherence, and adverse outcomes. This scientific statement reviews contemporary evidence informing antiplatelet strategies and highlights the critical role of the multidisciplinary cardiovascular team (interventional cardiology, general cardiology, pharmacists, advanced practice nurses) and the importance of their collective expertise in ensuring antithrombotic stewardship in patients with acute coronary syndrome and chronic coronary disease.