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European Radiology
Published in: European Radiology 11/2019

01-11-2019 | Acute Coronary Syndrome | Cardiac

Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

Authors: Jiesuck Park, Joo Myung Lee, Bon-Kwon Koo, Gilwoo Choi, Doyeon Hwang, Tae-Min Rhee, Seokhun Yang, Jonghanne Park, Jinlong Zhang, Kyung-Jin Kim, Yaliang Tong, Joon-Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Young-Seok Cho, Eun Ju Chun, Jin-Ho Choi, Bjarne L. Norgaard, Evald H. Christiansen, Koen Niemen, Hiromasa Otake, Martin Penicka, Bernard de Bruyne, Takashi Kubo, Takashi Akasaka, Jagat Narula, Pamela S. Douglas, Charles A. Taylor

Published in: European Radiology | Issue 11/2019

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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.
Appendix
Available only for authorised users
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Metadata
Title
Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome
Authors
Jiesuck Park
Joo Myung Lee
Bon-Kwon Koo
Gilwoo Choi
Doyeon Hwang
Tae-Min Rhee
Seokhun Yang
Jonghanne Park
Jinlong Zhang
Kyung-Jin Kim
Yaliang Tong
Joon-Hyung Doh
Chang-Wook Nam
Eun-Seok Shin
Young-Seok Cho
Eun Ju Chun
Jin-Ho Choi
Bjarne L. Norgaard
Evald H. Christiansen
Koen Niemen
Hiromasa Otake
Martin Penicka
Bernard de Bruyne
Takashi Kubo
Takashi Akasaka
Jagat Narula
Pamela S. Douglas
Charles A. Taylor
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06221-9

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