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Influence of Pullback Pressure Gradient on Residual Angina at One Year
Takuya Mizukami1,2, Kazumasa Ikeda1,3, Daniel Munhoz1
1Cardiovascular Center Aalst, AZORG, Aalst, Belgium (T.M., K.I., D.M., K.S., J.S., T. Storozhenko, F.B., E.W., A.W., B.D.B., C.C.).
Circulation. Cardiovascular Interventions
|February 2, 2026
Summary
Focal coronary artery disease, identified by pullback pressure gradient (PPG), is linked to less residual angina after treatment compared to diffuse disease. PPG may guide revascularization strategies for improved patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Physiological Measurements
Background:
- The pullback pressure gradient (PPG) is a new metric to classify coronary artery disease (CAD) as focal or diffuse.
- Understanding the relationship between PPG and symptom burden is crucial for treatment decisions.
Purpose of the Study:
- To assess the association between PPG-defined coronary artery disease patterns and residual angina at one year.
- To evaluate the utility of PPG in predicting symptom relief after revascularization.
Main Methods:
- The PPG Global study prospectively enrolled 947 patients with significant coronary lesions (FFR ≤0.80).
- Coronary artery disease was categorized as focal or diffuse based on PPG values (median 0.62).
- Patient-reported outcomes, including angina frequency, were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up.
Main Results:
- Patients with focal CAD reported significantly less angina at 1 year compared to those with diffuse CAD (p=0.006).
- Higher PPG values, indicative of focal disease, were independently associated with improved angina symptoms (p=0.017).
Conclusions:
- Focal coronary artery disease, as identified by high PPG, is associated with greater symptomatic relief at 1 year post-treatment.
- PPG serves as a valuable physiological tool to inform revascularization strategies by reflecting disease patterns and their impact on symptom relief.
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