Long-Term Prognostic Value of Lesion- And Vessel-Specific Physiological and Plaque Features at Coronary CT Angiography
Seokhun Yang1, Joon-Hyung Doh2, Sanda Jegere3, Andrejs Erglis3, Jonathon Leipsic4, Gilwoo Choi5, Kristaps Zarins6, Charles Anthony Taylor5, William F. Fearon7, Bon-Kwon Koo1
Seoul National University Hospital, Korea (Republic of)1, Inje University Ilsan Paik Hospital, Korea (Republic of)2, Pauls Stradins Clinical University Hospital, Latvia3, St. Paul's Hospital, Canada4, HeartFlow, Inc., USA5, Stanford University Medical Center, USA6, Stanford University, USA7
Comprehensive prognostic implications of coronary CT angiography (CCTA)-derived hemodynamic assessment and plaque quantification with long-term outcome data have not been identified.
The study participants were from the first-in-human study of CTA-derived FFR (FFRCT), the DISCOVER-FLOW study (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve, NCT01189331), who were enrolled from October 2009 to January 2011 and were followed up until December 2020. A total of 136 lesions in 78 vessels deferred from revascularization were included in the current analysis. FFRCT, wall shear stress (WSS), change in FFRCT across the lesion (ΔFFRCT), total plaque volume (TPV), percent atheroma volume (PAV), and low-attenuation plaque volume (LAPV) for target lesions [L] and vessels [V] were obtained by independent core laboratories. Their individual and combined prognostic value was evaluated for the clinical endpoints of target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization) and target lesion failure (TLF, a composite of cardiac death, target vessel myocardial infarction, target lesion revascularization).
The mean % diameter stenosis and FFRCT were 43.9 ± 10.8% and 0.80 ± 0.12, respectively. During a median follow-up of 10.1 years, TPV[V] ≥174.7 mm3 (Hazard ratio [HR] 6.2, P<0.01), PAV[V] ≥15.9% (HR 5.4, P =0.02), and FFRCT[V] ≤0.80 (HR 3.7, P =0.03) were independent predictors of TVF for the per-vessel analysis, and WSS[L] ≥284.5 dyne/cm2 (HR 5.0, P <0.01), LAPV[L]≥1.3 mm3 (HR 4.9, P =0.02), and ΔFFRCT[L]≥0.06 (HR 5.4, P =0.0495) were independent predictors of TLF for the per-lesion analysis after adjustment for % diameter stenosis and clinical characteristics. The rates of TVF and TLF serially increased according to the presence of 0,1, and ≥2 vessel-level and lesion-level outcome predictors, respectively (both P for trend <0.01).
Vessel- and lesion-level physiological characteristics, and vessel-level plaque quantity, and lesion-level plaque compositional characteristics assessed by CTA offer independent and additive long-term prognostic value.