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Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

  • Jiesuck Park
  • Joo Myung Lee
  • Bon-Kwon KooEmail author
  • Gilwoo Choi
  • Doyeon Hwang
  • Tae-Min Rhee
  • Seokhun Yang
  • Jonghanne Park
  • Jinlong Zhang
  • Kyung-Jin Kim
  • Yaliang Tong
  • Joon-Hyung Doh
  • Chang-Wook Nam
  • Eun-Seok Shin
  • Young-Seok Cho
  • Eun Ju Chun
  • Jin-Ho Choi
  • Bjarne L. Norgaard
  • Evald H. Christiansen
  • Koen Niemen
  • Hiromasa Otake
  • Martin Penicka
  • Bernard de Bruyne
  • Takashi Kubo
  • Takashi Akasaka
  • Jagat Narula
  • Pamela S. Douglas
  • Charles A. Taylor
Cardiac
  • 193 Downloads

Abstract

Objectives

We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS).

Methods

From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain.

Results

Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050–0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027–0.029) and plaque volume (0.023, 95% CI 0.022–0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31–8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36–4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724–0.727).

Conclusion

Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions.

Key Points

• Change in FFR CT across the lesion (ΔFFR CT ) was the most important predictor of ACS risk in non-obstructive lesions.

• Non-obstructive lesions with higher ΔFFR CT or low-attenuation plaque were associated with a higher risk of ACS.

• The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.

Keywords

Plaque, atherosclerotic Acute coronary syndrome Coronary stenosis Hemodynamics Computed tomography angiography 

Abbreviations

%DS

Percent diameter stenosis

ACS

Acute coronary syndrome

AUC

Area under the curve

CCTA

Coronary computed tomography angiography

CFD

Computational fluid dynamics

FFRCT

Coronary CT angiography-derived fractional flow reserve

MI

Myocardial infarction

SCD

Sudden cardiac death

ΔFFRCT

Delta FFRCT

Notes

Funding

This study was funded by HeartFlow Inc. The company performed the computational fluid dynamics analysis, but had no role in study design, study conduct, or manuscript preparation.

Compliance with ethical standards

Conflict of interest

Dr. Choi, and Dr. Taylor are employees of HeartFlow, Inc. Dr. De Bruyne is a shareholder for HeartFlow.

Guarantor

The scientific guarantor of this publication is BK Koo.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

The study protocol was approved by the institutional review board. The clinical trial registration number of this article is NCT02374775.

Methodology

• retrospective

• observational study

• multi-center study

Supplementary material

330_2019_6221_MOESM1_ESM.docx (97 kb)
ESM 1 (DOCX 97 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Jiesuck Park
    • 1
  • Joo Myung Lee
    • 2
  • Bon-Kwon Koo
    • 1
    • 3
    Email author
  • Gilwoo Choi
    • 4
  • Doyeon Hwang
    • 1
  • Tae-Min Rhee
    • 1
  • Seokhun Yang
    • 1
  • Jonghanne Park
    • 1
  • Jinlong Zhang
    • 1
  • Kyung-Jin Kim
    • 1
  • Yaliang Tong
    • 5
  • Joon-Hyung Doh
    • 6
  • Chang-Wook Nam
    • 7
  • Eun-Seok Shin
    • 8
  • Young-Seok Cho
    • 9
  • Eun Ju Chun
    • 10
  • Jin-Ho Choi
    • 2
  • Bjarne L. Norgaard
    • 11
  • Evald H. Christiansen
    • 11
  • Koen Niemen
    • 12
    • 13
  • Hiromasa Otake
    • 14
  • Martin Penicka
    • 15
  • Bernard de Bruyne
    • 15
  • Takashi Kubo
    • 16
  • Takashi Akasaka
    • 16
  • Jagat Narula
    • 17
  • Pamela S. Douglas
    • 18
  • Charles A. Taylor
    • 4
    • 19
  1. 1.Department of Internal Medicine and Cardiovascular CenterSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Institute on AgingSeoul National UniversitySeoulRepublic of Korea
  4. 4.HeartFlow, Inc.Redwood CityUSA
  5. 5.Department of CardiologyChina-Japan Union Hospital of Jilin UniversityChangchunChina
  6. 6.Department of MedicineInje University Ilsan Paik HospitalGoyangRepublic of Korea
  7. 7.Department of MedicineKeimyung University Dongsan Medical CenterDaeguRepublic of Korea
  8. 8.Department of CardiologyUlsan HospitalUlsanRepublic of Korea
  9. 9.Department of MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  10. 10.Department of RadiologySeoul National University Bundang HospitalSeongnamRepublic of Korea
  11. 11.Department of CardiologyAarhus University HospitalAarhusDenmark
  12. 12.Erasmus University Medical CenterRotterdamNetherlands
  13. 13.Cardiovascular InstituteStanford University, School of MedicineStanfordUSA
  14. 14.Department of Internal Medicine, Division of Cardiovascular and Respiratory MedicineKobe University Graduate School of MedicineKobeJapan
  15. 15.Cardiovascular Center Aalst, OLV-ClinicAalstBelgium
  16. 16.Department of Cardiovascular MedicineWakayama Medical UniversityWakayamaJapan
  17. 17.Icahn School of Medicine at Mount Sinai HospitalNew YorkUSA
  18. 18.Duke Clinical Research InstituteDuke University School of MedicineDurhamUSA
  19. 19.Department of BioengineeringStanford UniversityStanfordUSA

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