Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions

Kazumasa Ikeda; Takuya Mizukami; Koshiro Sakai; Frederic Bouisset; Jeroen Sonck; Adriaan Wilgenhof; Hitoshi Matsuo; Toshiro Shinke; Hirohiko Ando; Masahiro Hada; Brian Sh Ko; Simone Biscaglia; Fernando Rivero; Thomas Engstroem; Antonio Maria Leone; Lokien Xavier van Nunen; William F Fearon; Evald H Christiansen; Stephane Fournier; Liyew Desta; Andy S Yong; Julien Adjedj; Javier Escaned; Masafumi Nakayama; Ashkan Eftekhari; Danielle Cj Keulards; Frederik M Zimmermann; Tatyana Storozhenko; Bruno Roza da Costa; Gianluca Campo; Colin Berry; Damien Collison; Thomas William Johnson; Daniel B Munhoz; Tetsuya Amano; Divaka Perera; Allen Jeremias; Ziad A Ali; Takashi Kubo; Kazuhiro Satomi; Nobuhiro Tanaka; Bernard De Bruyne; Nils P Johnson; Carlos Collet

doi:10.1161/CIRCINTERVENTIONS.125.016022

Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions

Kazumasa Ikeda, Takuya Mizukami, Koshiro Sakai, Frederic Bouisset, Jeroen Sonck, Adriaan Wilgenhof, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Masahiro Hada, Brian Sh Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstroem, Antonio Maria Leone, Lokien Xavier van Nunen, William F Fearon, Evald H Christiansen, Stephane Fournier, Liyew DestaAndy S Yong, Julien Adjedj, Javier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Danielle Cj Keulards, Frederik M Zimmermann, Tatyana Storozhenko, Bruno Roza da Costa, Gianluca Campo, Colin Berry, Damien Collison, Thomas William Johnson, Daniel B Munhoz, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A Ali, Takashi Kubo, Kazuhiro Satomi, Nobuhiro Tanaka, Bernard De Bruyne, Nils P Johnson, Carlos Collet^*

^*Corresponding author for this work

Department of Cardiology

1 Citation (Scopus)

Abstract

BACKGROUND: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI.

METHODS: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization.

RESULTS: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR ( r=0.92 [95% CI, 0.91-0.93]; P<0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of target vessel failure (adjusted hazard ratio,1.97 [95% CI, 1.24-3.15]; P=0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes.

CONCLUSIONS: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

Original language	English
Journal	Circulation. Cardiovascular interventions
Volume	18
Issue number	12
Pages (from-to)	e016022
ISSN	1941-7640
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.125.016022
Publication status	Published - Dec 2025

Keywords

Humans
Percutaneous Coronary Intervention/adverse effects
Male
Female
Fractional Flow Reserve, Myocardial
Aged
Prospective Studies
Middle Aged
Treatment Outcome
Coronary Artery Disease/physiopathology
Predictive Value of Tests
Risk Factors
Time Factors
Cardiac Catheterization
Risk Assessment
Coronary Vessels/physiopathology
coronary artery disease
myocardial infarction
prognosis
percutaneous coronary intervention
fractional flow reserve, myocardial

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10.1161/CIRCINTERVENTIONS.125.016022

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Ikeda, K., Mizukami, T., Sakai, K., Bouisset, F., Sonck, J., Wilgenhof, A., Matsuo, H., Shinke, T., Ando, H., Hada, M., Ko, B. S., Biscaglia, S., Rivero, F., Engstroem, T., Leone, A. M., van Nunen, L. X., Fearon, W. F., Christiansen, E. H., Fournier, S., ... Collet, C. (2025). Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions. Circulation. Cardiovascular interventions, 18(12), e016022. https://doi.org/10.1161/CIRCINTERVENTIONS.125.016022

Ikeda, K, Mizukami, T, Sakai, K, Bouisset, F, Sonck, J, Wilgenhof, A, Matsuo, H, Shinke, T, Ando, H, Hada, M, Ko, BS, Biscaglia, S, Rivero, F, Engstroem, T, Leone, AM, van Nunen, LX, Fearon, WF, Christiansen, EH, Fournier, S, Desta, L, Yong, AS, Adjedj, J, Escaned, J, Nakayama, M, Eftekhari, A, Keulards, DC, Zimmermann, FM, Storozhenko, T, Roza da Costa, B, Campo, G, Berry, C, Collison, D, Johnson, TW, Munhoz, DB, Amano, T, Perera, D, Jeremias, A, Ali, ZA, Kubo, T, Satomi, K, Tanaka, N, De Bruyne, B, Johnson, NP & Collet, C 2025, 'Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions', Circulation. Cardiovascular interventions, vol. 18, no. 12, pp. e016022. https://doi.org/10.1161/CIRCINTERVENTIONS.125.016022

@article{07da172502464d7a96c2180fb8fd1286,

title = "Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions",

abstract = "BACKGROUND: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI.METHODS: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization.RESULTS: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR ( r=0.92 [95\% CI, 0.91-0.93]; P<0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of target vessel failure (adjusted hazard ratio,1.97 [95\% CI, 1.24-3.15]; P=0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes. CONCLUSIONS: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.",

keywords = "Humans, Percutaneous Coronary Intervention/adverse effects, Male, Female, Fractional Flow Reserve, Myocardial, Aged, Prospective Studies, Middle Aged, Treatment Outcome, Coronary Artery Disease/physiopathology, Predictive Value of Tests, Risk Factors, Time Factors, Cardiac Catheterization, Risk Assessment, Coronary Vessels/physiopathology, coronary artery disease, myocardial infarction, prognosis, percutaneous coronary intervention, fractional flow reserve, myocardial",

author = "Kazumasa Ikeda and Takuya Mizukami and Koshiro Sakai and Frederic Bouisset and Jeroen Sonck and Adriaan Wilgenhof and Hitoshi Matsuo and Toshiro Shinke and Hirohiko Ando and Masahiro Hada and Ko, \{Brian Sh\} and Simone Biscaglia and Fernando Rivero and Thomas Engstroem and Leone, \{Antonio Maria\} and \{van Nunen\}, \{Lokien Xavier\} and Fearon, \{William F\} and Christiansen, \{Evald H\} and Stephane Fournier and Liyew Desta and Yong, \{Andy S\} and Julien Adjedj and Javier Escaned and Masafumi Nakayama and Ashkan Eftekhari and Keulards, \{Danielle Cj\} and Zimmermann, \{Frederik M\} and Tatyana Storozhenko and \{Roza da Costa\}, Bruno and Gianluca Campo and Colin Berry and Damien Collison and Johnson, \{Thomas William\} and Munhoz, \{Daniel B\} and Tetsuya Amano and Divaka Perera and Allen Jeremias and Ali, \{Ziad A\} and Takashi Kubo and Kazuhiro Satomi and Nobuhiro Tanaka and \{De Bruyne\}, Bernard and Johnson, \{Nils P\} and Carlos Collet",

year = "2025",

month = dec,

doi = "10.1161/CIRCINTERVENTIONS.125.016022",

language = "English",

volume = "18",

pages = "e016022",

journal = "Circulation. Cardiovascular interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

TY - JOUR

T1 - Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions

AU - Ikeda, Kazumasa

AU - Mizukami, Takuya

AU - Sakai, Koshiro

AU - Bouisset, Frederic

AU - Sonck, Jeroen

AU - Wilgenhof, Adriaan

AU - Matsuo, Hitoshi

AU - Shinke, Toshiro

AU - Ando, Hirohiko

AU - Hada, Masahiro

AU - Ko, Brian Sh

AU - Biscaglia, Simone

AU - Rivero, Fernando

AU - Engstroem, Thomas

AU - Leone, Antonio Maria

AU - van Nunen, Lokien Xavier

AU - Fearon, William F

AU - Christiansen, Evald H

AU - Fournier, Stephane

AU - Desta, Liyew

AU - Yong, Andy S

AU - Adjedj, Julien

AU - Escaned, Javier

AU - Nakayama, Masafumi

AU - Eftekhari, Ashkan

AU - Keulards, Danielle Cj

AU - Zimmermann, Frederik M

AU - Storozhenko, Tatyana

AU - Roza da Costa, Bruno

AU - Campo, Gianluca

AU - Berry, Colin

AU - Collison, Damien

AU - Johnson, Thomas William

AU - Munhoz, Daniel B

AU - Amano, Tetsuya

AU - Perera, Divaka

AU - Jeremias, Allen

AU - Ali, Ziad A

AU - Kubo, Takashi

AU - Satomi, Kazuhiro

AU - Tanaka, Nobuhiro

AU - De Bruyne, Bernard

AU - Johnson, Nils P

AU - Collet, Carlos

PY - 2025/12

Y1 - 2025/12

N2 - BACKGROUND: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI.METHODS: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization.RESULTS: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR ( r=0.92 [95% CI, 0.91-0.93]; P<0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of target vessel failure (adjusted hazard ratio,1.97 [95% CI, 1.24-3.15]; P=0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes. CONCLUSIONS: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

AB - BACKGROUND: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI.METHODS: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary end point was target vessel failure at 1 year. Target vessel failure was defined as a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target vessel revascularization.RESULTS: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement, -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR ( r=0.92 [95% CI, 0.91-0.93]; P<0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of target vessel failure (adjusted hazard ratio,1.97 [95% CI, 1.24-3.15]; P=0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes. CONCLUSIONS: PPG-predicted post-PCI physiology was associated with target vessel failure at 1 year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

KW - Humans

KW - Percutaneous Coronary Intervention/adverse effects

KW - Male

KW - Female

KW - Fractional Flow Reserve, Myocardial

KW - Aged

KW - Prospective Studies

KW - Middle Aged

KW - Treatment Outcome

KW - Coronary Artery Disease/physiopathology

KW - Predictive Value of Tests

KW - Risk Factors

KW - Time Factors

KW - Cardiac Catheterization

KW - Risk Assessment

KW - Coronary Vessels/physiopathology

KW - coronary artery disease

KW - myocardial infarction

KW - prognosis

KW - percutaneous coronary intervention

KW - fractional flow reserve, myocardial

UR - https://www.scopus.com/pages/publications/105027423036

U2 - 10.1161/CIRCINTERVENTIONS.125.016022

DO - 10.1161/CIRCINTERVENTIONS.125.016022

M3 - Journal article

C2 - 41137850

SN - 1941-7640

VL - 18

SP - e016022

JO - Circulation. Cardiovascular interventions

JF - Circulation. Cardiovascular interventions

IS - 12

ER -

Impact of Pullback Pressure Gradient on Clinical Outcomes after Percutaneous Coronary Interventions

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