Influence of pullback pressure gradient on residual angina at one year

The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease (CAD) patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and patient-reported outcomes at one-year.

PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least one lesion with a fractional flow reserve (FFR) ≤ 0.80 intended to be treated with PCI. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of PCI. 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 (SAQ) at baseline and one-year follow-up.

The study included 947 patients with PPG and SAQ at one year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At one year, patients with focal CAD reported less angina than those with diffuse CAD (SAQ angina frequency score 95.3±9.9 vs. 92.5±15.0, p=0.006). PPG was independently associated with angina improvement (p = 0.017). At one year, there was no difference in the target vessel failure rate between patients with focal and diffuse CAD (6.9% vs. 9.1%, p=0.265)

In patients with flow-limiting CAD, the presence of focal disease defined by high PPG was associated with greater symptomatic relief at one year compared to diffuse disease (low PPG). PPG has the potential to optimize revascularization decisions.

Graphical Abstract