Impact of CT-angiography derived plaque characteristics on cardiac events in patients with a negative invasive fractional flow reserve

• Published in: International journal of cardiology 2024-12, Vol.421, p.132895, Article 132895
• Main Authors: Ozaki, Reina, Motoyama, Sadako, Ozaki, Yukio, Sarai, Masayoshi, Kawai, Hideki, Ismail, Tevfik F., Fujiwara, Wakaya, Miyajima, Keiichi, Nagahara, Yasuomi, Uchida, Noriya, Garg, Scot, Kawashima, Naoyuki, Niwa, Yudai, Takatsu, Hidemaro, Yoshiki, Yu, Ohta, Masaya, Muramatsu, Takashi, Harada, Masahide, Naruse, Hiroyuki, Matsui, Ayaka, Kamiya, Haruo, Tobe, Akihiko, Tsung-Ying, Tsai, Bando, Yasuko, Onuma, Yoshinobu, Takahashi, Hiroshi, Izawa, Hideo, Serruys, Patrick W., Murohara, Toyoaki
• Format: Article
• Language: English
• Subjects: CCS; CT-angiography; Deferral lesion; FFR; High-risk plaque; MACE
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132895

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR > 0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events. We examined 373 consecutive CCS patients undergoing CTA followed not more than 90 days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32 months. Revascularization was performed in 131 of the 373 patients due to an FFR ≤ 0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR > 0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4 % versus 10.1 %, p = 0.90), whilst in the Defer group they were higher in patients with HRP (21.1 % versus 4.7 %, Log-rank-p