Takuya Mizukami, Kazumasa Ikeda, Daniel Munhoz, KOSHIRO SAKAI, Jeroen Sonck, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Antonio Maria Leone, Lokien X. van Nunen, William F. Fearon, Esben Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien Adjedj, J A V I E R Escaned, Masafumi Nakayama, Ashkan Eftekhari, Frederik M. Zimmermann, Tatyana Storozhenko, Frédéric Bouisset, Domenico Galante, Bruno R. da Costa, Gianluca Campo, C Berry, Damien Collison, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A. Ali, Ethan C Korngold, Eric Wyffels, Adriaan Wilgenhof, N H J Pijls, Bernard De Bruyne, Nils P. Johnson, Carlos Collet
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.