Koshiro Sakai; Jeroen Sonck; Takuya Mizukami; Hitoshi Matsuo; Brian Ko; Divaka Perera; Hirohiko Ando; Simone Biscaglia; Fernando Rivero; Antonio Leone; Liyew Desta; Javier Escaned; Masafumi Nakayama; Daniel Munhoz; Tatyana Storozhenko; Hirofumi Ohashi; Gianluca Campo; Tetsuya Amano; Toshiro Shinke; Ziad Ali; Bernard De Bruyne; Nils Johnson; Carlos Collet; Allen Jeremias

doi:10.4244/EIJ-D-25-00025

Validation of the pullback pressure gradient in resting conditions

Koshiro Sakai¹^,²^,³, MD, PhD; Jeroen Sonck¹, MD, PhD; Takuya Mizukami¹^,⁴^,⁵, MD, PhD; Hitoshi Matsuo⁵, MD, PhD; Brian Ko⁶, MD, PhD; Divaka Perera⁷, MD, FRCP; Hirohiko Ando⁸, MD, PhD; Simone Biscaglia⁹, MD, PhD; Fernando Rivero¹⁰, MD, PhD; Antonio Maria Leone¹¹^,¹², MD, PhD; Liyew Desta¹³, MD, PhD; Javier Escaned¹⁴, MD, PhD; Masafumi Nakayama¹⁵, MD, PhD; Daniel Munhoz¹, MD, PhD; Tatyana Storozhenko¹^,¹⁶, MD; Hirofumi Ohashi⁸, MD, PhD; Gianluca Campo⁹, MD, PhD; Tetsuya Amano⁸, MD, PhD; Toshiro Shinke², MD, PhD; Ziad Ali³, MD, DPhil; Bernard De Bruyne¹^,¹⁷, MD, PhD; Nils P. Johnson¹⁸, MD, MS; Carlos Collet¹, MD, PhD; Allen Jeremias³, MD, MSc

The pullback pressure gradient (PPG) is a novel metric that quantifies coronary artery disease (CAD) patterns as focal or diffuse on a scale from 0 (diffuse) to 1 (focal)1. PPG predicts blood flow improvement after percutaneous coronary intervention (PCI): a high PPG (focal disease) is associated with greater flow improvement and angina relief, while a low PPG (diffuse disease) is linked to higher periprocedural complications23. Traditionally, PPG has been derived from fractional flow reserve (FFR) pullbacks. However, assessment using non-hyperaemic pressure ratios (NHPR) can shorten procedure time and eliminate the need for a hyperaemic agent. This study aimed to assess the agreement between resting and hyperaemic PPG.

This study was a prespecified subanalysis of the PPG Global Registry, a prospective, investigator-initiated, multicentre, international study (ClinicalTrials.gov: NCT04789317)2. Eligible patients had at least one haemodynamically significant lesion (FFR ≤0.80) scheduled for PCI, with those undergoing both resting and hyperaemic pressure pullbacks included (Supplementary Figure 1). The pressure wire (PressureWire X [Abbott]) was placed in the distal coronary artery to measure resting distal coronary pressure/aortic pressure, resting full-cycle...

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