Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome
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We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS).
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.
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).
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.
• 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.
KeywordsPlaque, atherosclerotic Acute coronary syndrome Coronary stenosis Hemodynamics Computed tomography angiography
Percent diameter stenosis
Acute coronary syndrome
Area under the curve
Coronary computed tomography angiography
Computational fluid dynamics
Coronary CT angiography-derived fractional flow reserve
Sudden cardiac death
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.
The scientific guarantor of this publication is BK Koo.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
The study protocol was approved by the institutional review board. The clinical trial registration number of this article is NCT02374775.
• observational study
• multi-center study
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