Influence of Pullback Pressure Gradient on Residual Angina at One Year.
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Mizukami Takuya, Ikeda Kazumasa, Munhoz Daniel, Sakai Koshiro, Sonck Jeroen, Matsuo Hitoshi, Shinke Toshiro, Ando Hirohiko, Ko Brian, Biscaglia Simone, Rivero Fernando, Engstrøm Thomas, Leone Antonio Maria, van Nunen Lokien X, Fearon William F, Christiansen Evald Høj, Fournier Stephane, Desta Liyew, Yong Andy, Adjedj Julien, Escaned Javier, Nakayama Masafumi, Eftekhari Ashkan, Zimmermann Frederik M, Storozhenko Tatyana, Bouisset Frédéric, Galante Domenico, da Costa Bruno R, Campo Gianluca, Berry Colin, Collison Damien, Amano Tetsuya, Perera Divaka, Jeremias Allen, Ali Ziad A, Korngold Ethan, Wyffels Eric, Wilgenhof Adriaan, Pijls Nico, De Bruyne Bernard, Johnson Nils P, Collet Carlos
Аннотация
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.