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JACC Cardiovasc Imaging. 2025;18(7):784-795.

Prognostic Time Frame of Plaque and Hemodynamic Characteristics and Integrative Risk Prediction for Acute Coronary Syndrome.

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제1저자 양석훈 · 교신저자 구본권

PMID 40272335 DOI 10.1016/j.jcmg.2025.02.003 IF 19 순환기내과
소속 (45)
  1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College of Medicine, Seoul, South Korea.
  2. Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  3. Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
  4. Department of Cardiology, Eulji University Medical Center, Daejeon, South Korea.
  5. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
  6. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.
  7. Department of Cardiology, Ulsan Medical Center, Ulsan, South Korea.
  8. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
  9. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
  10. Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea.
  11. Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, South Korea.
  12. Department of Cardiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea.
  13. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
  14. Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju, South Korea.
  15. Department of Cardiology, Odense University Hospital, Svendborg, Denmark.
  16. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  17. Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
  18. Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
  19. The Heart and Vascular Center, Semmelweis University, Semmelweis University, Budapest, Hungary.
  20. Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
  21. Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
  22. Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
  23. Blavatnik Family Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  24. Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA.
  25. Department of Cardiology, Washington University School of Medicine in St. Louis, Missouri, USA.
  26. Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
  27. Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
  28. Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan.
  29. Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan.
  30. Department of Cardiology, Aichi Medical University, Nagakute, Japan.
  31. Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
  32. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
  33. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
  34. Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan.
  35. Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan.
  36. Cardiovascular Center, Shin-Koga Hospital, Kurume, Japan.
  37. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
  38. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
  39. Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
  40. Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
  41. Department of Internal Medicine and Oden Institute for Computational Engineering and Sciences, University of Texas, Austin, Texas, USA.
  42. Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, the Netherlands.
  43. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  44. McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA.
  45. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College of Medicine, Seoul, South Korea. Electronic address: bkkoo@snu.ac.kr.

Abstract

BACKGROUND The relevant time frame for predicting future acute coronary syndrome (ACS) based on coronary lesion characteristics remains uncertain.

OBJECTIVES The aim of this study was to investigate the association of lesion characteristics with test-to-event time and their prognostic impact on ACS.

METHODS The EMERALD II (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II) study analyzed 351 patients who underwent coronary computed tomography angiography (CTA) and experienced ACS between 1 month and 3 years of follow-up. Lesions identified on coronary CTA were classified as culprit (n = 363) or nonculprit (n = 2,088) on the basis of invasive coronary angiography findings at the time of ACS. Core laboratory coronary CTA analyses assessed 4 domains: degree of stenosis, plaque burden, number of adverse plaque characteristics (APC) (low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign), and changes in coronary CTA-derived fractional flow reserve across the lesion (ΔFFRCT). Patients were categorized into short (<1 year), mid (1-2 years), and long (2-3 years) test-to-event time groups.

RESULTS Patient characteristics, including cardiovascular risk factors, did not differ across short, mid, and long test-to-event groups (P > 0.05 for all), and the proportion of ACS culprit lesions was similar (P = 0.552). Among culprit lesions, shorter test-to-event time was associated with higher luminal stenosis, plaque burden, and ΔFFRCT (P for trend < 0.001 for all). The predictability for ACS culprit lesions based on the combined 4 characteristics tended to decrease over time and significantly reduced beyond 2 years (AUC: 0.851 vs 0.741; P = 0.006). In predicting ACS risk within test-to-event time <2 years using obstructive lesions (stenosis ≥ 50%), APC ≥2, plaque burden ≥70%, and ΔFFRCT ≥0.10, the risk was elevated compared to the average proportion of lesions becoming ACS culprit (12.1%) in the following subsets: lesions with 4 characteristics (proportion of lesions becoming ACS culprit: 49.3%; P < 0.001), lesions with 3 characteristics (obstructive lesions with plaque burden ≥70% and either ΔFFRCT ≥0.10 [proportion of lesions becoming ACS culprit: 33.0%; P < 0.001] or APC ≥2 [proportion of lesions becoming ACS culprit: 31.2%; P < 0.001]), and lesions with 2 characteristics (plaque burden ≥70% and ΔFFRCT ≥0.10; proportion of lesions becoming ACS culprit: 21.5%; P = 0.016).

CONCLUSIONS Increased luminal stenosis, plaque burden, and ΔFFRCT were associated with shorter test-to-ACS event time. The prognostic impact of lumen, plaque, and local hemodynamic characteristics was most relevant to ACS risk within a 2-year period, with higher risk observed when specific combinations of them were present. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II] Study; NCT03591328).

Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Keywords

acute coronary syndromeatherosclerosiscoronary CT angiographycoronary physiologyvulnerable plaque

Conflict of interest statement

Funding Support and Author Disclosures This study received funding from HeartFlow. HeartFlow performed computational fluid dynamics analysis and quantitative coronary plaque analysis. This study was also supported by the Technology Innovation Program–Advanced Cardiovascular Biomechanical 3D Modeling and Simulation Software: Using Clinical Data and Biometric Signals (RS-2024-00444631) funded by the Ministry of Trade, Industry and Energy (Korea) and grants from the Ministry of Food and Drug Safety (RS-2023-00215667) in 2024 (Korea). The study funders had no role in trial design, data collection, analysis, and interpretation, or writing of the manuscript. Dr Koo has received institutional research grants from Abbott, Philips, and HeartFlow. Dr Nam has received institutional research grants from Abbott and Genoss. Dr Merkely has received direct personal payment for speaker fees or studies from Abbott, AstraZeneca, Biotronik, Boehringer Ingelheim, CSL Behring, Daiichi Sankyo, Duke Clinical Research Institute, Medtronic, and Novartis; and institutional grants from Abbott, AstraZeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CSL Behring, Daiichi Sankyo, Duke Clinical Research Institute, Eli Lilly, Medtronic, Novartis, Terumo, and Vifor Pharma. Dr de Bruyne has received institutional unrestricted research grants from Abbott, Boston Scientific, and Biotronik; has received consulting fees from Abbott, Opsens, and Boston Scientific; and is a shareholder of Siemens, GE, Bayer, Philips, HeartFlow, Edwards Lifesciences, Sanofi, and Omega Pharma. Dr Ko has equity in Artrya; and has received honoraria from Medtronic, Abbott Vascular, and Canon Medical. Dr Leipsic is a consultant for and holds stock options in HeartFlow; and has received modest personal core laboratory fees from Arineta. Dr Shah has received honoraria as a speaker from HeartFlow. Dr Matsuo has received honoraria from Abbott Medical Japan, Phillips, Boston Scientific Japan, and Zeon Medical. Dr Shaw has received honoraria from HeartFlow and Elucid Imaging. Dr Taylor is a shareholder of HeartFlow. Dr Bax has received unrestricted research grants from Abbott and Edwards Lifesciences. Dr Nørgaard has received unrestricted research grants from the NovoNordic Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

그 밖의 정보
출판 형태
Journal Article, Observational Study
저널
JACC. Cardiovascular imaging · eISSN 1876-7591
전자 출판
2025-04-23
MeSH
Aged · Female · Humans · Male · Middle Aged · Acute Coronary Syndrome* / physiopathology / diagnostic imaging / etiology · Computed Tomography Angiography* · Coronary Artery Disease* / physiopathology / diagnostic imaging / complications / pathology · Coronary Stenosis* / physiopathology / diagnostic imaging · Coronary Vessels* / diagnostic imaging / physiopathology · Fractional Flow Reserve, Myocardial · Hemodynamics* · Plaque, Atherosclerotic* · Predictive Value of Tests · Prognosis · Risk Assessment · Risk Factors · Rupture, Spontaneous · Severity of Illness Index · Time Factors
데이터
ClinicalTrials.gov: NCT03591328