Key result
Focal CAD is linked to less residual angina at 1 year compared to diffuse disease.
Why the study?
The pullback pressure gradient (PPG) is a novel physiological metric that quantifies CAD patterns, but its relationship with residual angina at 1 year remained to be assessed.
Does focal coronary artery disease defined by high pullback pressure gradient (PPG) improve residual angina at 1 year compared to diffuse disease in patients with flow-limiting CAD?
Does focal coronary artery disease defined by high pullback pressure gradient (PPG) improve residual angina at 1 year compared to diffuse disease in patients with flow-limiting CAD?
In patients with flow-limiting coronary artery disease, focal disease defined by a high pullback pressure gradient is associated with significantly greater symptomatic relief of angina at 1 year compared to diffuse disease.
Answers are grounded in this paper and cite their sources.
High PPG may identify CAD patients with greater post-treatment angina relief; extends physiological phenotyping to symptoms but leaves open RCT confirmation.
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.
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Mizukami et al. (2026) studied this question. In patients with coronary artery disease, focal disease (high PPG) improved angina score at 1 year compared to diffuse disease (95.3 vs 92.5; P=0.006).
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