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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Influence of Pathophysiologic Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention
Carlos Collet1, Daniel Munhoz1,2, Takuya Mizukami1,3
1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (C.C., D.M., T.M., J.S., K.S., T. Storozhenko, T.D.P., W.H., D.B., J.B., B.D.B.).
Insights
The pullback pressure gradient (PPG) effectively predicts optimal revascularization outcomes in patients undergoing percutaneous coronary intervention (PCI). PPG offers superior predictive value for PCI success compared to fractional flow reserve (FFR) alone.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Techniques
Background:
- Diffuse coronary artery disease complicates percutaneous coronary intervention (PCI) safety and efficacy.
- Fractional flow reserve (FFR) pullbacks, using pullback pressure gradient (PPG) calculation, quantify coronary artery disease pathophysiology.
- Understanding these patterns is crucial for optimizing PCI outcomes.
Purpose of the Study:
- To assess the predictive capacity of PPG for achieving optimal revascularization after PCI.
- To evaluate PPG's ability to forecast procedural success and patient outcomes.
- To compare PPG's predictive performance against traditional FFR measurements.
Main Methods:
- A prospective, single-arm, multicenter study enrolled 993 patients with FFR ≤0.80 scheduled for PCI.
- Manual FFR pullbacks were performed to calculate PPG.
- Optimal revascularization was defined as a post-PCI FFR ≥0.88.
Main Results:
- PPG demonstrated strong correlation with post-PCI FFR changes (r=0.65, P<0.001).
- PPG showed excellent predictive capacity for optimal revascularization (AUC=0.82, P<0.001), outperforming FFR alone (AUC=0.54).
- Low PPG (<0.62) was associated with increased periprocedural myocardial infarction (OR=1.71).
Conclusions:
- Pathophysiologic coronary artery disease patterns significantly impact PCI safety and effectiveness.
- PPG is a valuable tool for predicting optimal revascularization and procedural success.
- PPG provides added clinical value beyond FFR measurements in guiding PCI decisions.
Background:
Diffuse coronary artery disease affects the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiologic coronary artery disease patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularization and procedural outcomes.
Methods:
This prospective, investigator-initiated, single-arm, multicenter study enrolled patients with at least one epicardial lesion with an FFR ≤0.80 scheduled for PCI. Manual FFR pullbacks were used to calculate PPG. The primary outcome of optimal revascularization was defined as an FFR ≥0.88 after PCI.
Results:
A total of 993 patients with 1044 vessels were included. The mean FFR was 0.68±0.12, PPG 0.62±0.17, and the post-PCI FFR was 0.87±0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65 [95% CI, 0.61-0.69]; P<0.001) and demonstrated excellent predictive capacity for optimal revascularization (area under the receiver operating characteristic curve, 0.82 [95% CI, 0.79-0.84]; P<0.001). FFR alone did not predict revascularization outcomes (area under the receiver operating characteristic curve, 0.54 [95% CI, 0.50-0.57]). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared with those with focal disease (odds ratio, 1.71 [95% CI, 1.00-2.97]).
Conclusions:
Pathophysiologic coronary artery disease patterns distinctly affect the safety and effectiveness of PCI. PPG showed an excellent predictive capacity for optimal revascularization and demonstrated added value compared with an FFR measurement.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789317.
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