Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan.
Curr Opin Cardiol. 2024 Nov 1;39(6):520-528. doi: 10.1097/HCO.0000000000001179. Epub 2024 Sep 19.
This review evaluates the emerging role of the pullback pressure gradient (PPG) as a standardized metric for assessing coronary artery disease (CAD) patterns and its implications for clinical decision-making when managing patients undergoing percutaneous coronary interventions (PCIs). By integrating PPG with existing physiological assessments, this review highlights the potential benefits of PPG in predicting treatment outcomes and refining therapeutic strategies for CAD.
Recent studies, particularly the PPG Global study have demonstrated a strong correlation between PPG values and post-PCI outcomes, revealing that focal disease is associated with improved fractional flow reserve (FFR) and lower rates of adverse events than vessels with diffuse disease (low PPG). Additionally, PPG has been linked to specific atherosclerotic plaque characteristics, indicating its utility in identifying high-risk plaques. The integration of PPG with advanced imaging techniques further enhances the understanding of CAD patterns and their implications for treatment planning.
The PPG represents a significant advancement in the management of CAD, providing a reproducible and objective assessment of coronary artery disease patterns that can inform clinical decision-making. As research continues to explore the relationship among PPG, atherosclerotic characteristics, and patient outcomes, its integration into routine practice is expected to improve the effectiveness of PCI and optimize patient management strategies. Future studies are warranted to establish specific PPG thresholds and further investigate its potential in identifying vulnerable plaques and guiding treatment decisions.
本综述评估了回撤压力梯度（PPG）作为评估冠状动脉疾病（CAD）模式的标准化指标的新作用，及其在管理接受经皮冠状动脉介入治疗（PCI）的患者时对临床决策的影响。通过将 PPG 与现有的生理评估相结合，本综述强调了 PPG 在预测治疗结果和改进 CAD 治疗策略方面的潜在益处。
最近的研究，特别是 PPG 全球研究，表明 PPG 值与 PCI 后结果之间存在很强的相关性，表明局灶性病变与改善的血流储备分数（FFR）和较低的不良事件发生率相关，而弥漫性病变（低 PPG）的血管则相反。此外，PPG 与特定的动脉粥样硬化斑块特征相关，表明其在识别高危斑块方面的效用。PPG 与先进的成像技术相结合，进一步增强了对 CAD 模式及其对治疗计划影响的理解。
PPG 是 CAD 管理的重大进展，提供了一种可重复和客观的冠状动脉疾病模式评估方法，可以为临床决策提供信息。随着研究继续探索 PPG、动脉粥样硬化特征和患者结果之间的关系，预计将其纳入常规实践将提高 PCI 的有效性并优化患者管理策略。需要进一步的研究来确定特定的 PPG 阈值，并进一步研究其在识别易损斑块和指导治疗决策方面的潜力。
