AUTHOR=Lee Seung Hun , Hong David , Dai Neng , Shin Doosup , Choi Ki Hong , Kim Sung Mok , Kim Hyun Kuk , Jeon Ki-Hyun , Ha Sang Jin , Lee Kwan Yong , Park Taek Kyu , Yang Jeong Hoon , Song Young Bin , Hahn Joo-Yong , Choi Seung-Hyuk , Choe Yeon Hyeon , Gwon Hyeon-Cheol , Ge Junbo , Lee Joo Myung 

TITLE=Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.871450

DOI=10.3389/fcvm.2022.871450

ISSN=2297-055X

ABSTRACT=Objectives: While CCTA enables evaluation of anatomic and hemodynamic plaque characteristics of coronary artery disease (CAD), the clinical roles of these characteristics are not clear. We sought to evaluate prognostic implications of coronary computed tomography angiography (CCTA)-derived anatomic and hemodynamic plaque characteristics in prediction of subsequent coronary events.
Methods: Study cohort consisted of 158 patients who underwent CCTA with suspected CAD within 6 to 36 months prior to percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) or unstable angina and age/sex matched 62 patients without PCI as control group. Preexisting high-risk plaque characteristics and hemodynamic parameters were analyzed from prior CCTA. Primary outcome was subsequent coronary event which was defined as a composite of vessel-specific MI or revascularization for unstable angina. Prognostic impact of clinical risk factors, HRPC and hemodynamic parameters were compared between vessels with (160 vessels) and without subsequent coronary events (329 vessels). 
Results: Vessels with subsequent coronary event had higher number of HRPC (2.6±1.4 vs. 2.3±1.4, P=0.012), lower FFRCT (0.76±0.13 vs. 0.82±0.11, P<0.001), higher ∆FFRCT (0.14±0.12 vs. 0.09±0.08, P<0.001), and higher percent ischemic myocardial mass (29.0±18.5 vs. 26.0±18.4, P=0.022) than those without subsequent coronary event. Compared with clinical risk factors, HRPC and hemodynamic parameters showed higher discriminant abilities for subsequent coronary event with ∆FFRCT being the most powerful predictor. HRPC showed additive discriminant ability to clinical risk factors (c-index 0.620 vs. 0.558, P=0.027), and hemodynamic parameters further increased discriminant ability (c-index 0.698 vs. 0.620, P=0.001) and reclassification abilities (NRI 0.460, IDI 0.061, P<0.001 for all) for subsequent coronary events. Among vessels with negative FFRCT (>0.80), adding HRPC into clinical risk factors significantly increased discriminant and reclassification abilities for subsequent coronary event (c-index 0.687 vs. 0.576, P=0.005; NRI 0.412, P=0.002; IDI 0.064, P=0.001), however, not for vessels with positive FFRCT (≤0.80).
Conclusions: In predicting subsequent coronary events, both HRPC and hemodynamic parameters by CCTA allow better prediction of subsequent coronary events than clinical risk factors. HRPC provides incremental predictability than clinical risk factors alone among vessels with negative FFRCT, but not among vessels with positive FFRCT.