What is the clinical evidence from this study?

Study design: Observational. Population: Intermediate coronary stenosis (n=159). Intervention: Coronary CTA and OCT. Primary outcome: Lesions causing ischemia (FFR ≤0.80) (OR 2.78, 5.13, 3.25, 2.57, p=0.038, 0.042, 0.017, 0.012).

What question did this study set out to answer?

This study investigates the link between fractional flow reserve and plaque characteristics assessed by coronary CTA and OCT in patients with intermediate coronary stenosis.

April 21, 2026Open Access

Predictive value of plaque characteristics assessed by coronary computed tomography angiography and optical coherence tomography for identification of lesions causing ischemia

Q: What does this research mean for the field?

Low attenuation plaque on coronary CTA, along with thrombus, plaque rupture, and intimal vasculature on OCT, independently predict ischemia-causing lesions in patients with intermediate coronary stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Low attenuation plaque on CTA (OR 2.78) and thrombus (OR 5.13), plaque rupture (OR 3.25), and intimal vasculature on OCT (OR 2.57) independently predicted ischemia-causing lesions (FFR ≤0.80).

Key Points

This study investigates the link between fractional flow reserve and plaque characteristics assessed by coronary CTA and OCT in patients with intermediate coronary stenosis.
Conducted as a prospective multicentre registry involving 159 patients with 339 coronary lesions.
Performed coronary CTA, followed by FFR measurement and OCT during angiography.
Considered stenotic lesions with FFR ≤0.80 as diagnostic for ischemia.
Identified differences in stenosis severity and plaque characteristics between ischemic and non-ischemic lesions.
Low attenuation plaque on CTA (OR=2.78; P=0.038) and thrombus (OR=5.13; P=0.042) were significant predictors of ischemia.
Incremental improvement in ischemia prediction associated with increasing plaque characteristics.

Study Design

Type

Observational (n=159)

Multicenter

Yes

Structured PICO

Do specific plaque characteristics assessed by coronary CTA and OCT predict ischemia-causing lesions in patients with intermediate coronary stenosis?

Population

159 patients including 339 coronary lesions with intermediate stenosis

Intervention

Plaque characteristics assessment by coronary computed tomography angiography (CTA) and optical coherence tomography (OCT)

Outcome

Identification of lesions causing ischemia (defined as fractional flow reserve [FFR] ≤0.80)surrogate

Specific high-risk plaque features identified on coronary CTA and OCT, such as low attenuation, thrombus, and rupture, independently predict which intermediate coronary lesions cause ischemia as measured by FFR.

Main Result

Effect estimate: OR 2.78, 5.13, 3.25, 2.57

p-value: p=0.038, 0.042, 0.017, 0.012

Abstract

Abstract Background In patients with intermediate coronary stenosis, the functional assessment with fractional flow reserve (FFR) and the anatomical assessment with optical coherence tomography (OCT) have been widely used in clinical practice. Additionally, coronary computed tomography angiography (CTA) is commonly used non-invasive imaging technique for evaluating suspected coronary artery disease before being referred for angiography. Objectives This study sought to investigate the association between FFR and plaque characteristics assessed by coronary CTA and OCT in intermediate coronary stenosis. Methods Based on the prospective multicentre registry, a total of 159 patients including 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography and both FFR measurement and OCT examination were performed during angiography. The stenotic lesion with FFR ≤0.80 was considered diagnostic of lesion causing ischemia. The predictive value of plaque characteristics assessed by coronary CTA and OCT for identifying lesions causing ischemia was analyzed. Results Stenosis severity and plaque characteristics on coronary CTA and OCT were different between the lesions causing ischemia versus not causing ischemia. On multivariate analysis, low attenuation plaque on coronary CTA (odds ratio OR= 2.78; P=0.038) and thrombus (OR=5.13; 0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors for the lesions causing ischemia. Increasing number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia. Conclusions Comprehensive anatomical evaluation of coronary stenosis may be able to provide additional supportive information for predicting the lesions causing ischemia.