Coronary angiography is the foundational technology that allows the cardiologist to visualize the coronary vasculature. However, coronary lumenograms alone are inadequate to assess the total burden of atherosclerotic disease, the physiologic significance of epicardial disease, or the status of microvascular function. Yet even after decades of research and advances in intravascular ultrasound and coronary physiologic measurements such as fractional flow reserve, we continue to call such technologies adjunctive, as in “added to something else as a supplement rather than an essential part” according to the Oxford English dictionary. Much of this may result from the need to insert a specialty catheter or guidewire to take measurements, and only in selected cases. Clinical studies of such measurements have historically focused on the minimal luminal area (MLA), in part because integrating the total plaque burden over multiple images has been laborious or subject to error.