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Eur Radiol. 2019;29(11):6119-6128.

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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제1저자 박지석, 이주명 · 교신저자 구본권

PMID 31025066 DOI 10.1007/s00330-019-06221-9 IF 6 순환기내과
소속 (20)
  1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Republic of Korea.
  2. Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  3. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul, 110-744, Republic of Korea. bkkoo@snu.ac.kr.
  4. Institute on Aging, Seoul National University, Seoul, Republic of Korea. bkkoo@snu.ac.kr.
  5. HeartFlow, Inc., Redwood City, CA, USA.
  6. Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
  7. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
  8. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
  9. Department of Cardiology, Ulsan Hospital, Ulsan, Republic of Korea.
  10. Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
  11. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
  12. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  13. Erasmus University Medical Center, Rotterdam, Netherlands.
  14. Cardiovascular Institute, Stanford University, School of Medicine, Stanford, CA, USA.
  15. Department of Internal Medicine, Division of Cardiovascular and Respiratory Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
  16. Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
  17. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
  18. Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
  19. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
  20. Department of Bioengineering, Stanford University, Stanford, CA, USA.

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

Acute coronary syndromeComputed tomography angiographyCoronary stenosisHemodynamicsPlaque, atherosclerotic

그 밖의 정보
출판 형태
Journal Article
저널
European radiology · eISSN 1432-1084
전자 출판
2019-04-25
MeSH
Acute Coronary Syndrome / diagnosis / physiopathology · Aged · Computed Tomography Angiography / methods · Coronary Angiography / methods · Coronary Vessels / diagnostic imaging · Female · Hemodynamics / physiology · Humans · Male · Plaque, Atherosclerotic / diagnosis / physiopathology · Predictive Value of Tests
참고문헌
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