Author + information
- Jiesuck Park1,
- Joo Myung Lee2,
- Doyeon Hwang3,
- Tae-Min Rhee4,
- Jonghanne Park5,
- Ki Hong Choi6,
- Bon-Kwon Koo3,
- Gilwoo Choi7,
- Charles Taylor8,
- Jung-Kyu Han3,
- Han-Mo Yang9,
- Kyung Woo (KW) Park3 and
- Hyo-Soo Kim3
- 1Seoul National University Hostpital, Seoul, Korea, Republic of
- 2Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
- 3Seoul National University Hospital, Seoul, Korea, Republic of
- 4National Maritime Medical Center, Seoul, Korea, Republic of
- 5Ministry of Health and Welfare, Seoul, Korea, Republic of
- 6Samsung Medical Center, Seoul, Korea, Republic of
- 7HeartFlow, Inc., Redwood City, California, United States
- 8HeartFlow, Inc., Redwood City, California, United States
- 9Seoul National University Hospital, seoul, Korea, Republic of
We investigated the clinical relevance of adverse plaque characteristics (APC) and adverse hemodynamic characteristics (AHC) for identifying high risk plaques causing acute coronary syndrome (ACS) in patients with non-obstructive stenosis.
Among the EMERALD study subjects with ACS and available coronary CT angiography (cCTA) before ACS, 132 lesions without significant stenosis (<50%, 24 culprit and 108 non-culprit lesions) were included. APC was defined as low-attenuation plaque, positive remodeling, napkin-ring sign, or spotty calcification. AHC was defined as low fractional flow reserve derived by cCTA (FFRCT≤0.80), △FFRCT across the lesion≥0.06, or high wall shear stress (WSS≥154.7dyn/cm2).
Despite no significant difference in %DS (39.7±6.5% vs. 36.3±9.9%, p=0.105) and FFRCT (0.80±0.09 vs. 0.80±0.13, p=0.817), culprit lesions showed higher incidence of APC (63% vs. 38%, p=0.039), higher △FFRCT (p=0.003) and WSS (p=0.023) than non-culprit lesions. When the lesions were classified according to the presence of APC and AHC, the lesions with both APC and AHC showed the highest risk of ACS (HR 8.50, 95% CI 1.88-38.38, p=0.005) (Figure). In multivariable analysis to find independent predictor for subsequent ACS showed that the presence of AHC (HR 2.538, 95% CI 1.177-5.472, p=0.018) or APC (HR 2.259, 95% CI 1.006-5.071.p=0.048) possessed independent association with the occurrence of future ACS (C-index 0.738, 95% CI 0.718-0.758).
Non-invasive assessment of APC and AHC by cCTA can identify high risk plaques for subsequent ACS among lesions without significant stenosis.
IMAGING: FFR and Physiologic Lesion Assessment