High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization
Seokhun Yang, Bon-Kwon Koo, Doyeon Hwang, Jinlong Zhang, Masahiro Hoshino, Joo Myung Lee, Tadashi Murai, Jiesuck Park, Eun-Seok Shin, Joon-Hyung Doh, Chang-Wook Nam, Jianan Wang, Shaoliang Chen, Nobuhiro Tanaka, Hitoshi Matsuo, Takashi Akasaka, Hyuk-Jae Chang, Tsunekazu Kakuta, Jagat Narula, Seokhun Yang, Bon-Kwon Koo, Doyeon Hwang, Jinlong Zhang, Masahiro Hoshino, Joo Myung Lee, Tadashi Murai, Jiesuck Park, Eun-Seok Shin, Joon-Hyung Doh, Chang-Wook Nam, Jianan Wang, Shaoliang Chen, Nobuhiro Tanaka, Hitoshi Matsuo, Takashi Akasaka, Hyuk-Jae Chang, Tsunekazu Kakuta, Jagat Narula
Abstract
Objectives: This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI).
Background: Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes.
Methods: A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm2 and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm3 and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years.
Results: The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.
Conclusions: High-risk morphological attributes offered additive prognostic value to coronary physiology and may optimize selection of treatment strategies by adding to FFR-based risk predictions (CCTA-FFR Registry for Development of Comprehensive Risk Prediction Model; NCT04037163).
Keywords: atherosclerosis; coronary artery disease; fractional flow reserve; lesion-specific ischemia; plaque characteristics.
Conflict of interest statement
Funding Support and Author Disclosures Drs. Koo and Lee have received institutional research grants from Abbott Vascular and Philips Volcano. Dr. Doh have received research grants from Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed