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Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography

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Author(s)
Seokhun YangMasahiro HoshinoTaishi YonetsuJinlong ZhangDoyeon HwangEun-Seok ShinJoon-Hyung DohChang-Wook NamJianan WangShaoliang ChenNobuhiro TanakaHitoshi MatsuoTakashi KuboHyuk-Jae ChangTsunekazu KakutaBon-Kwon Koo
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
EuroIntervention
Issued Date
2023
Volume
18
Issue
12
Abstract
Background:
The integrative implications of quantitative and qualitative plaque characteristics on clinical outcomes and therapeutic guidance have not been fully investigated.

Aims:
We aimed to investigate the combined prognostic value of quantitative and qualitative plaque measures and their interactions with treatment modalities and physiological lesion severity.

Methods:
Among 697 vessels from 458 patients who underwent fractional flow reserve (FFR)-guided treatment, quantitative high-risk plaque (qn-HRP; plaque burden ≥70% and minimum lumen area <3.3 mm2) and qualitative HRP (ql-HRP; low-attenuation plaque or positive remodelling) were defined on coronary computed tomography angiography (CCTA). The primary endpoint was the vessel-oriented composite outcome (VOCO; a composite of cardiac death, myocardial infarction, or revascularisation).

Results:
The mean baseline FFR was 0.85±0.12, and 25.8% underwent percutaneous coronary intervention (PCI) during the index procedure. In medically treated lesions, both qn-HRP and ql-HRP were associated with an increased risk of VOCO (p<0.05). Relative to the lesions with qn-HRP(-)/ql-HRP(-),those with qn-HRP(+)/ql-HRP(+) showed a higher risk of VOCO (hazard ratio [HR] 8.36, 95% confidence interval [CI]: 2.86-24.44). The PCI group showed a lower risk for VOCO than the medical treatment group (HR 0.31, 95% CI: 0.11-0.91) in lesions with qn-HRP(+)/ql-HRP(+). This difference was consistent in lesions with an FFR of 0.81-0.90 (HR 0.19, 95 CI: 0.04-0.90), but not in those with an FFR of>0.90.

Conclusions:
In non-ischaemic lesions, ql-HRP and qn-HRP showed a synergistic impact on risk assessment and had prognostic interactions with FFR and treatment modalities. Therefore, they need to be integrated into risk stratification and the optimisation of a treatment strategy.

Clinicaltrials:
gov: NCT04037163.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1969-6213
Source
https://eurointervention.pcronline.com/article/outcomes-of-non-ischaemic-coronary-lesions-with-high-risk-plaque-characteristics-on-coronary-ct-angiography
DOI
10.4244/EIJ-D-22-00562
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44729
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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