A computing system (118) includes a computer readable storage medium (122) with computer executable instructions (124), including a biophysical simulator (126) and an electrocardiogram signal analyzer (128). The computing system further includes a processor (120) configured to execute the electrocardiogram signal analyzer determine myocardial infarction characteristics from an input electrocardiogram and to execute the biophysical simulator to simulate a fractional flow reserve or an instant wave-free ratio index from input cardiac image data and the determined myocardial infarction characteristics.