Influence of Pullback Pressure Gradient on Residual Angina at One Year

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; Evald Høj Christiansen; Stephane Fournier; Liyew Desta; Andy Yong; Julien Adjedj; Javier Escaned; Masafumi Nakayama; Ashkan Eftekhari; Frederik M Zimmermann; Tatyana Storozhenko; Frédéric Bouisset; Domenico Galante; Bruno R da Costa; Gianluca Campo; Colin Berry; Damien Collison; Tetsuya Amano; Divaka Perera; Allen Jeremias; Ziad A Ali; Ethan Korngold; Eric Wyffels; Adriaan Wilgenhof; Nico Pijls; Bernard De Bruyne; Nils P Johnson; Carlos Collet

doi:10.1161/CIRCINTERVENTIONS.125.015851

Influence of Pullback Pressure Gradient on Residual Angina at One Year

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, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Andy Yong, Julien AdjedjJavier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Frederik M Zimmermann, Tatyana Storozhenko, Frédéric Bouisset, Domenico Galante, Bruno R da Costa, Gianluca Campo, Colin Berry, Damien Collison, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A Ali, Ethan Korngold, Eric Wyffels, Adriaan Wilgenhof, Nico Pijls, Bernard De Bruyne, Nils P Johnson, Carlos Collet

Afdeling for Hjertesygdomme HJE

Abstract

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 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 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 coronary artery 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, the presence of focal disease defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By reflecting the physiological pattern of disease and its relation to symptom relief after treatment, PPG may help inform revascularization strategies.

Originalsprog	Engelsk
Tidsskrift	Circulation. Cardiovascular interventions
Sider (fra-til)	e015851
ISSN	1941-7640
DOI	https://doi.org/10.1161/CIRCINTERVENTIONS.125.015851
Status	E-pub ahead of print - 2 feb. 2026

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10.1161/CIRCINTERVENTIONS.125.015851Licens: CC BY-NC-ND

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Mizukami, T., Ikeda, K., Munhoz, D., Sakai, K., Sonck, J., Matsuo, H., Shinke, T., Ando, H., Ko, B., Biscaglia, S., Rivero, F., Engstrøm, T., Leone, A. M., van Nunen, L. X., Fearon, W. F., Christiansen, E. H., Fournier, S., Desta, L., Yong, A., ... Collet, C. (2026). Influence of Pullback Pressure Gradient on Residual Angina at One Year. Circulation. Cardiovascular interventions, e015851. Advance online publication. https://doi.org/10.1161/CIRCINTERVENTIONS.125.015851

Mizukami, T, Ikeda, K, Munhoz, D, Sakai, K, Sonck, J, Matsuo, H, Shinke, T, Ando, H, Ko, B, Biscaglia, S, Rivero, F, Engstrøm, T, Leone, AM, van Nunen, LX, Fearon, WF, Christiansen, EH, Fournier, S, Desta, L, Yong, A, Adjedj, J, Escaned, J, Nakayama, M, Eftekhari, A, Zimmermann, FM, Storozhenko, T, Bouisset, F, Galante, D, da Costa, BR, Campo, G, Berry, C, Collison, D, Amano, T, Perera, D, Jeremias, A, Ali, ZA, Korngold, E, Wyffels, E, Wilgenhof, A, Pijls, N, De Bruyne, B, Johnson, NP & Collet, C 2026, 'Influence of Pullback Pressure Gradient on Residual Angina at One Year', Circulation. Cardiovascular interventions, s. e015851. https://doi.org/10.1161/CIRCINTERVENTIONS.125.015851

@article{9c8e937100094a96a635ecda0369e8f1,

title = "Influence of Pullback Pressure Gradient on Residual Angina at One Year",

abstract = "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 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 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 coronary artery 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, the presence of focal disease defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By reflecting the physiological pattern of disease and its relation to symptom relief after treatment, PPG may help inform revascularization strategies.",

author = "Takuya Mizukami and Kazumasa Ikeda and Daniel Munhoz and Koshiro Sakai and Jeroen Sonck and Hitoshi Matsuo and Toshiro Shinke and Hirohiko Ando and Brian Ko and Simone Biscaglia and Fernando Rivero and Thomas Engstr{\o}m and Leone, {Antonio Maria} and {van Nunen}, {Lokien X} and Fearon, {William F} and Christiansen, {Evald H{\o}j} and Stephane Fournier and Liyew Desta and Andy Yong and Julien Adjedj and Javier Escaned and Masafumi Nakayama and Ashkan Eftekhari and Zimmermann, {Frederik M} and Tatyana Storozhenko and Fr{\'e}d{\'e}ric Bouisset and Domenico Galante and {da Costa}, {Bruno R} and Gianluca Campo and Colin Berry and Damien Collison and Tetsuya Amano and Divaka Perera and Allen Jeremias and Ali, {Ziad A} and Ethan Korngold and Eric Wyffels and Adriaan Wilgenhof and Nico Pijls and {De Bruyne}, Bernard and Johnson, {Nils P} and Carlos Collet",

year = "2026",

month = feb,

day = "2",

doi = "10.1161/CIRCINTERVENTIONS.125.015851",

language = "English",

pages = "e015851",

journal = "Circulation. Cardiovascular interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Influence of Pullback Pressure Gradient on Residual Angina at One Year

AU - Mizukami, Takuya

AU - Ikeda, Kazumasa

AU - Munhoz, Daniel

AU - Sakai, Koshiro

AU - Sonck, Jeroen

AU - Matsuo, Hitoshi

AU - Shinke, Toshiro

AU - Ando, Hirohiko

AU - Ko, Brian

AU - Biscaglia, Simone

AU - Rivero, Fernando

AU - Engstrøm, Thomas

AU - Leone, Antonio Maria

AU - van Nunen, Lokien X

AU - Fearon, William F

AU - Christiansen, Evald Høj

AU - Fournier, Stephane

AU - Desta, Liyew

AU - Yong, Andy

AU - Adjedj, Julien

AU - Escaned, Javier

AU - Nakayama, Masafumi

AU - Eftekhari, Ashkan

AU - Zimmermann, Frederik M

AU - Storozhenko, Tatyana

AU - Bouisset, Frédéric

AU - Galante, Domenico

AU - da Costa, Bruno R

AU - Campo, Gianluca

AU - Berry, Colin

AU - Collison, Damien

AU - Amano, Tetsuya

AU - Perera, Divaka

AU - Jeremias, Allen

AU - Ali, Ziad A

AU - Korngold, Ethan

AU - Wyffels, Eric

AU - Wilgenhof, Adriaan

AU - Pijls, Nico

AU - De Bruyne, Bernard

AU - Johnson, Nils P

AU - Collet, Carlos

PY - 2026/2/2

Y1 - 2026/2/2

N2 - 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 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 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 coronary artery 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, the presence of focal disease defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By reflecting the physiological pattern of disease and its relation to symptom relief after treatment, PPG may help inform revascularization strategies.

AB - 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 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 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 coronary artery 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, the presence of focal disease defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By reflecting the physiological pattern of disease and its relation to symptom relief after treatment, PPG may help inform revascularization strategies.

U2 - 10.1161/CIRCINTERVENTIONS.125.015851

DO - 10.1161/CIRCINTERVENTIONS.125.015851

M3 - Journal article

C2 - 41623057

SN - 1941-7640

SP - e015851

JO - Circulation. Cardiovascular interventions

JF - Circulation. Cardiovascular interventions

ER -

Influence of Pullback Pressure Gradient on Residual Angina at One Year

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