Prognostic Implications of Comprehensive Whole Vessel Plaque Quantification Using Coronary Computed Tomography Angiography

Seokhun Yang; Joo Myung Lee; Masahiro Hoshino; Tadashi Murai; Ki Hong Choi; Doyeon Hwang; Kyung-Jin Kim; Eun-Seok Shin; Joon-Hyung Doh; Hyuk-Jae Chang; Chang-Wook Nam; Jinlong Zhang; Jianan Wang; Shao-Liang Chen; Nobuhiro Tanaka; Hitoshi Matsuo; Takashi Akasaka; Tsunekazu Kakuta; Bon-Kwon Koo

doi:10.1016/j.jacasi.2021.05.003

Prognostic Implications of Comprehensive Whole Vessel Plaque Quantification Using Coronary Computed Tomography Angiography

JACC Asia. 2021 Jun 15;1(1):37-48. doi: 10.1016/j.jacasi.2021.05.003. eCollection 2021 Jun.

Authors

Seokhun Yang¹, Joo Myung Lee², Masahiro Hoshino³, Tadashi Murai³, Ki Hong Choi², Doyeon Hwang¹, Kyung-Jin Kim⁴, Eun-Seok Shin⁵, Joon-Hyung Doh⁶, Hyuk-Jae Chang⁷, Chang-Wook Nam⁸, Jinlong Zhang⁹, Jianan Wang⁹, Shao-Liang Chen¹⁰, Nobuhiro Tanaka¹¹, Hitoshi Matsuo¹², Takashi Akasaka¹³, Tsunekazu Kakuta³, Bon-Kwon Koo^{1

14}

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
² Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³ Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
⁴ Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea.
⁵ Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea and Division of Cardiology, Ulsan Hospital, Ulsan, Korea.
⁶ Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
⁷ Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea.
⁸ Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
⁹ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China.
¹⁰ Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
¹¹ Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
¹² Department of Cardiology, Gifu Heart Center, Gifu, Japan.
¹³ Wakayama Medical University, Wakayama, Japan.
¹⁴ Institute on Aging, Seoul National University, Seoul, Korea.

Abstract

Background: The prognostic value of whole vessel plaque quantification has not been fully understood.

Objectives: We aimed to investigate the clinical relevance of whole vessel plaque quantification on coronary computed tomography angiography.

Methods: In a total of 1,013 vessels with fractional flow reserve (FFR) measurement and available coronary computed tomography angiography, high-risk plaque characteristics (HRPC) included minimum lumen area <4 mm², plaque burden ≥70%, low attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign; and high-risk vessel characteristics (HRVC) included total plaque volume ≥306.5 mm³, fibrofatty and necrotic core volume ≥4.46 mm³, or percent total atheroma volume ≥32.2% in a target vessel, based on corresponding optimal cutoff values. Survival analysis for vessel-oriented composite outcome (VOCO) (a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization) at 5 years was performed using marginal Cox proportional hazard models.

Results: Whole vessel plaque quantification had incremental predictability in addition to % diameter stenosis and HRPC (P < 0.001) in predicting FFR ≤0.80. Among 517 deferred vessels based on FFR >0.80, the number of HRVC was significantly associated with the risk of VOCO (HR: 2.54; 95% CI: 1.77-3.64) and enhanced the predictability for VOCO of % diameter stenosis and the number of HRPC (P < 0.001). In a landmark analysis at 2 years, the number of HRVC showed sustained prognostic implications beyond 2 years, but the number of HRPC did not.

Conclusions: Whole vessel plaque quantification can provide incremental predictability for low FFR and additive prognostic value in deferred vessels with high FFR over anatomical severity and lesion plaque characteristics. (CCTA-FFR Registry for Risk Prediction; NCT04037163).

Keywords: CAD, coronary artery disease; CTA, computed tomography angiography; FFNC, fibrofatty and necrotic core; FFR, fractional flow reserve; HRPC, high-risk plaque characteristics; HRVC, high-risk vessel characteristics; MLA, minimum lumen area; VOCO, vessel-oriented composite outcome; atherosclerosis; coronary CT angiography; fractional flow reserve; plaque quantification.

Associated data

ClinicalTrials.gov/NCT04037163