Key result
Having ≥3 high-risk plaque characteristics is linked to ~4-fold higher VOCO risk despite FFR >0.80.
Why the study?
Limited data exist regarding the prognostic implications of combined physiological stenosis severity assessed by FFR and plaque vulnerability by coronary CTA-defined high-risk plaque characteristics in coronary artery disease patients.
Does the presence of high-risk plaque characteristics on coronary CTA provide incremental prognostic value over fractional flow reserve in patients with coronary artery disease?
Cohort (n=299)
Does the presence of high-risk plaque characteristics on coronary CTA provide incremental prognostic value over fractional flow reserve in patients with coronary artery disease?
Integration of physiological stenosis severity by FFR and plaque vulnerability by coronary CTA provides better prognostic stratification than either alone, particularly in non-ischemic lesions (FFR >0.80).
BACKGROUND: Although the presence of ischemia is a key prognostic factor in patients with coronary artery disease, the presence of high-risk plaque characteristics (HRPC) is also associated with increased risk of cardiovascular events. Limited data exist regarding the prognostic implications of combined information on physiological stenosis severity assessed by fractional flow reserve (FFR) and plaque vulnerability by coronary computed tomography angiography (CTA)-defined HRPC. OBJECTIVES: The current study aimed to evaluate the: 1) association between physiological stenosis severity and coronary CTA-defined HRPC; and 2) prognostic implications of coronary CTA-defined HRPC according to physiological stenosis severity in patients with coronary artery disease. METHODS: A total of 772 vessels (299 patients) evaluated by both coronary CTA and FFR were analyzed. The presence and number of HRPC (minimum lumen area <4 mm RESULTS: The proportion of lesions with ≥3 HRPC was significantly decreased according to the increase in FFR values (58.6%, 46.5%, 36.8%, 15.7%, and 3.5% for FFR ≤0.60, 0.61 to ≤0.70, 0.71 to ≤0.80, 0.81 to ≤0.90, and >0.90, respectively; overall p value <0.001). Both FFR and number of HRPC showed significant association with the estimated risk of VOCO (p = 0.008 and p = 0.023, respectively). In the FFR >0.80 group, lesions with ≥3 HRPC showed significantly higher risk of VOCO than those with <3 HRPC (15.0% vs. 4.3%; hazard ratio: 3.964; 95% confidence interval: 1.451 to 10.828; p = 0.007). However, there was no significant difference in the risk of VOCO according to HRPC in the FFR ≤0.80 group. By multivariable analysis, the presence of ≥3 HRPC was independently associated with the risk of VOCO in the FFR >0.80 group. CONCLUSIONS: Physiological stenosis severity and the number of HRPC were closely related, and both components had significant association with the risk of clinical events. However, the prognostic implication of HRPC was different according to FFR. Integration of both physiological stenosis severity and plaque vulnerability would provide better prognostic stratification of patients than either individual component alone, especially in patients with FFR >0.80. (Clinical Implication of 3-vessel Fractional Flow Reserve [3V FFR-FRIENDS study]; NCT01621438).
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Lee et al. (2019) conducted a cohort in Coronary artery disease (n=299). ≥3 high-risk plaque characteristics (HRPC) vs. <3 HRPC was evaluated on Vessel-oriented composite outcome (VOCO) (HR 3.964, 95% CI 1.451-10.828, p=0.007). In vessels with FFR >0.80, the presence of ≥3 high-risk plaque characteristics significantly increased the risk of VOCO compared to <3 HRPC (15.0% vs 4.3%; HR 3.964; 95% CI 1.451-10.828; P=0.007).
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