Related Experiment Video
Updated: Oct 16, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Integrated coronary disease burden and patterns to discriminate vessels benefiting from percutaneous coronary
Insights
The pullback pressure gradient (PPG) index helps predict outcomes in patients with coronary artery disease. Low PPG indicates higher risk, suggesting conservative treatment may be better for some patients receiving percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- The prognostic value of atherosclerosis functional patterns, specifically the quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) index, remains unclear.
- Characterizing atherosclerosis functional patterns is crucial for guiding treatment decisions in ischemic heart disease.
Purpose of the Study:
- To evaluate the prognostic implications of the QFR-derived PPG index in ischemia-causing vessels.
- To determine the association between PPG index, treatment strategy (PCI vs. conservative), and 2-year vessel-oriented composite outcomes (VOCO).
Main Methods:
- Retrospective analysis of 1444 vessels from the PANDA III trial.
- Calculation of QFR-derived PPG index to categorize vessels as low or high PPG.
- Comparison of 2-year VOCO risk (ischemia-driven revascularization, myocardial infarction, cardiac death) between treatment groups.
Main Results:
- Among vessels treated with PCI, low PPG was associated with a significantly higher VOCO risk compared to high PPG (8.4% vs. 3.8%).
- Vessels with low PPG treated with PCI had similar VOCO risk as those treated conservatively (8.4% vs. 7.8%).
- The PPG index independently predicted VOCO and improved predictive models when added to clinical risk factors.
Conclusions:
- Percutaneous coronary intervention (PCI) improved outcomes in vessels with high PPG but not in those with low PPG.
- Low PPG vessels showed similar outcomes whether treated with PCI or conservatively, suggesting a potential role for conservative management.
- QFR-derived PPG index may aid in selecting optimal treatment strategies for ischemia-causing vessels.
Objective:
To evaluate the prognostic implications of atherosclerosis functional pattern on ischemia-causing vessels received percutaneous coronary intervention (PCI) or conservative treatment.
Background:
Quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) index is recently proposed to characterize atherosclerosis functional pattern, but its prognostic value remains unclear.
Methods:
QFR-derived PPG index was retrospectively calculated in patients from the PANDA III trial. Vessels with low or high PPG treated by PCI or not were compared for the risk of 2-year vessel-oriented composite outcome (VOCO), which was a composite of vessel-related ischemia-driven revascularization, vessel-related myocardial infarction, or cardiac death.
Results:
A total of 1444 vessels were included while 94 (6.5%) VOCOs occurred within 2 years. Among physiologically ischemic vessels (QFR ≤ 0.80) treated by PCI, those with low PPG acquired higher VOCO risk than those with high PPG (8.4% vs. 3.8%; adjusted hazard ratio [HR] 2.13, 95% confidence interval [CI] 1.18 to 3.86), and a similar VOCO risk (8.4% vs. 7.8%; adjusted HR 1.11, 95%CI 0.70-1.78) compared to those treated by conservatively. After multiple adjustment, PPG index was an independent predictor for VOCO (HR 1.30, 95% CI 1.05-1.62). The addition of PPG to the model of clinical risk factors substantially improved the predictions of VOCO (C-index 0.67 vs. 0.62, net reclassification index 0.42).
Conclusions:
PCI treatment was associated with improved outcomes in vessels with high PPG, but not for those with low PPG, which acquired similar risk of VOCO compared to vessels treated conservatively. QFR-derived PPG might assist the treatment strategy selection in ischemia-causing vessels.
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