TY - JOUR
T1 - Influence of pullback pressure gradient on residual angina at one year
AU - Mizukami, Takuya
AU - Ikeda, Kazumasa
AU - Munhoz, Daniel
AU - Sakai, Koshiro
AU - Sonck, Jeroen
AU - Matsuo, Hitoshi
AU - Shinke, Toshiro
AU - Ando, Hirohiko
AU - Ko, Brian
AU - Biscaglia, Simone
AU - Rivero, Fernando
AU - Engstrøm, Thomas
AU - Leone, Antonio Maria
AU - van Nunen, Lokien X.
AU - Fearon, William F.
AU - Christiansen, Evald Høj
AU - Fournier, Stephane
AU - Desta, Liyew
AU - Yong, Andy
AU - Adjedj, Julien
AU - Escaned, Javier
AU - Nakayama, Masafumi
AU - Eftekhari, Ashkan
AU - Zimmermann, Frederik M.
AU - Storozhenko, Tatyana
AU - Bouisset, Frédéric
AU - Galante, Domenico
AU - da Costa, Bruno R.
AU - Campo, Gianluca
AU - Berry, Colin
AU - Collison, Damien
AU - Amano, Tetsuya
AU - Perera, Divaka
AU - Jeremias, Allen
AU - Ali, Ziad A.
AU - Korngold, Ethan
AU - Wyffels, Eric
AU - Wilgenhof, Adriaan
AU - Pijls, Nico
AU - De Bruyne, Bernard
AU - Johnson, Nils P.
AU - Collet, Carlos
N1 - Copyright the Author(s) 2026. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2026/3/1
Y1 - 2026/3/1
N2 - BACKGROUND: The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year. METHODS: PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up. RESULTS: The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; P=0.006). PPG was independently associated with improvement in angina (P=0.017). CONCLUSIONS: In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.
AB - BACKGROUND: The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year. METHODS: PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up. RESULTS: The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; P=0.006). PPG was independently associated with improvement in angina (P=0.017). CONCLUSIONS: In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.
KW - coronary artery bypass
KW - coronary artery disease
KW - patient-centered care
KW - percutaneous coronary intervention
KW - physicians
UR - https://www.scopus.com/pages/publications/105033855218
U2 - 10.1161/CIRCINTERVENTIONS.125.015851
DO - 10.1161/CIRCINTERVENTIONS.125.015851
M3 - Article
C2 - 41623057
AN - SCOPUS:105033855218
SN - 1941-7640
VL - 19
SP - 209
EP - 221
JO - Circulation. Cardiovascular interventions
JF - Circulation. Cardiovascular interventions
IS - 3
M1 - e015851
ER -