Pullback Pressure Gradient-An Emerging Concept in Patients with Coronary Artery Disease

Abstract

Fractional flow reserve fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is currently recommended in the management of patients with stable coronary artery disease (CAD). Pullback pressure gradient (PPG) index is an emerging concept that provides a fully quantitative measure of the longitudinal distribution of CAD. It can be derived from FFR, as well as other non-hyperemic indices, and is a novel metric of assessing the focality or diffuseness of CAD. PPG adds a second domain to the assessment of CAD, beyond ischemia as measured by FFR, and may enable clinicians to better inform their patients about the status of their CAD but may also predict potential outcomes before revascularization. In this article, we will provide an in-depth review on the concept of PPG index and its correlation to pre and post revascularization ischemia. We will assess the relationship between PPG index and plaque characteristics and how this is translated into any difference in procedural and long-term clinical outcomes.

Keywords: clinical outcomes; coronary artery disease; diffuse; focal; ischemia; physiology; pressure wire; pullback pressure gradient; symptoms.

Fig. 1.

Pullback pressure gradient calculation. MaxPPG, maximum pullback pressure gradient; $\mathrm{\Delta }$FFR, The decrease in fractional flow reserve (FFR) after adenosine administration from baseline FFR value.