Long-term prognostic implications of hemodynamic and plaque assessment using coronary CT angiography

• Published in: Atherosclerosis 2023-05, Vol.373, p.58-65
• Main Authors: Yang, Seokhun, Lesina, Krista, Doh, Joon-Hyung, Jegere, Sanda, Erglis, Andrejs, Leipsic, Jonathon A., Chun, Eun Ju, Choi, Gilwoo, Schaap, Michiel, Zarins, Christopher, Taylor, Charles A., Fearon, William F., Narula, Jagat, Koo, Bon-Kwon
• Format: Article
• Language: English
• Subjects: Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Stenosis - pathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Long-term prognosis; Low-attenuation plaque; Percent atheroma volume; Plaque, Atherosclerotic - pathology; Predictive Value of Tests; Prognosis; Tomography, X-Ray Computed; Total plaque volume; Wall shear stress
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2023.02.005

Hemodynamic and plaque characteristics can be analyzed using coronary CT angiography (CTA). We aimed to explore long-term prognostic implications of hemodynamic and plaque characteristics using coronary CT angiography (CTA). Invasive fractional flow reserve (FFR) and CTA-derived FFR (FFRCT) were undertaken for 136 lesions in 78 vessels and followed-up to 10 years until December 2020. FFRCT, wall shear stress (WSS), change in FFRCT across the lesion (ΔFFRCT), total plaque volume (TPV), percent atheroma volume (PAV), and low-attenuation plaque volume (LAPV) for target lesions [L] and vessels [V] were obtained by independent core laboratories. Their collective influence was evaluated for the clinical endpoints of target vessel failure (TVF) and target lesion failure (TLF). During a median follow-up of 10.1 years, PAV[V] (per 10% increase, HR 2.32 [95% CI 1.11–4.86], p = 0.025), and FFRCT[V] (per 0.1 increase, HR 0.56 [95% CI 0.37–0.84], p = 0.006) were independent predictors of TVF for the per-vessel analysis, and WSS[L] (per 100 dyne/cm2 increase, HR 1.43 [1.09–1.88], p = 0.010), LAPV[L] (per 10 mm3 increase, HR 3.81 [1.16–12.5], p = 0.028), and ΔFFRCT[L] (per 0.1 increase, HR 1.39 [1.02–1.90], p = 0.040) were independent predictors of TLF for the per-lesion analysis after adjustment for clinical and lesion characteristics. The addition of both plaque and hemodynamic predictors improved the predictability for 10-year TVF and TLF of clinical and lesion characteristics (all p