High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization

Seokhun Yang; Bon Kwon Koo; Doyeon Hwang; Jinlong Zhang; Masahiro Hoshino; Joo Myung Lee; Tadashi Murai; Jiesuck Park; Eun Seok Shin; Joon Hyung Doh; Chang Wook Nam; Jianan Wang; Shaoliang Chen; Nobuhiro Tanaka; Hitoshi Matsuo; Takashi Akasaka; Hyuk Jae Chang; Tsunekazu Kakuta; Jagat Narula

doi:10.1016/j.jcmg.2021.04.004

High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization

Seokhun Yang, Bon Kwon Koo, Doyeon Hwang, Jinlong Zhang, Masahiro Hoshino, Joo Myung Lee, Tadashi Murai, Jiesuck Park, Eun Seok Shin, Joon Hyung Doh, Chang Wook Nam, Jianan Wang, Shaoliang Chen, Nobuhiro Tanaka, Hitoshi Matsuo, Takashi Akasaka, Hyuk Jae Chang, Tsunekazu Kakuta, Jagat Narula

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI). Background: Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes. Methods: A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm² and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm³ and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years. Results: The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.

Original language	English
Pages (from-to)	1977-1989
Number of pages	13
Journal	JACC: Cardiovascular Imaging
Volume	14
Issue number	10
DOIs	https://doi.org/10.1016/j.jcmg.2021.04.004
State	Published - Oct 2021

Keywords

atherosclerosis
coronary artery disease
fractional flow reserve
lesion-specific ischemia
plaque characteristics

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10.1016/j.jcmg.2021.04.004

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Yang, S., Koo, B. K., Hwang, D., Zhang, J., Hoshino, M., Lee, J. M., Murai, T., Park, J., Shin, E. S., Doh, J. H., Nam, C. W., Wang, J., Chen, S., Tanaka, N., Matsuo, H., Akasaka, T., Chang, H. J., Kakuta, T., & Narula, J. (2021). High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization. JACC: Cardiovascular Imaging, 14(10), 1977-1989. https://doi.org/10.1016/j.jcmg.2021.04.004

@article{2fcea2f753b5499f8feee5abd8b36689,

title = "High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization",

abstract = "Objectives: This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI). Background: Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes. Methods: A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm2 and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm3 and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years. Results: The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.",

keywords = "atherosclerosis, coronary artery disease, fractional flow reserve, lesion-specific ischemia, plaque characteristics",

author = "Seokhun Yang and Koo, {Bon Kwon} and Doyeon Hwang and Jinlong Zhang and Masahiro Hoshino and Lee, {Joo Myung} and Tadashi Murai and Jiesuck Park and Shin, {Eun Seok} and Doh, {Joon Hyung} and Nam, {Chang Wook} and Jianan Wang and Shaoliang Chen and Nobuhiro Tanaka and Hitoshi Matsuo and Takashi Akasaka and Chang, {Hyuk Jae} and Tsunekazu Kakuta and Jagat Narula",

note = "Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = oct,

doi = "10.1016/j.jcmg.2021.04.004",

language = "English",

volume = "14",

pages = "1977--1989",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "10",

}

Yang, S, Koo, BK, Hwang, D, Zhang, J, Hoshino, M, Lee, JM, Murai, T, Park, J, Shin, ES, Doh, JH, Nam, CW, Wang, J, Chen, S, Tanaka, N, Matsuo, H, Akasaka, T, Chang, HJ, Kakuta, T & Narula, J 2021, 'High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization', JACC: Cardiovascular Imaging, vol. 14, no. 10, pp. 1977-1989. https://doi.org/10.1016/j.jcmg.2021.04.004

TY - JOUR

T1 - High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization

AU - Yang, Seokhun

AU - Koo, Bon Kwon

AU - Hwang, Doyeon

AU - Zhang, Jinlong

AU - Hoshino, Masahiro

AU - Lee, Joo Myung

AU - Murai, Tadashi

AU - Park, Jiesuck

AU - Shin, Eun Seok

AU - Doh, Joon Hyung

AU - Nam, Chang Wook

AU - Wang, Jianan

AU - Chen, Shaoliang

AU - Tanaka, Nobuhiro

AU - Matsuo, Hitoshi

AU - Akasaka, Takashi

AU - Chang, Hyuk Jae

AU - Kakuta, Tsunekazu

AU - Narula, Jagat

PY - 2021/10

Y1 - 2021/10

N2 - Objectives: This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI). Background: Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes. Methods: A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm2 and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm3 and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years. Results: The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.

AB - Objectives: This study sought to evaluate the prognostic impact of plaque morphology and coronary physiology on outcomes after medical treatment or percutaneous coronary intervention (PCI). Background: Although fractional flow reserve (FFR) is currently best practice, morphological characteristics of coronary artery disease also contribute to outcomes. Methods: A total of 872 vessels in 538 patients were evaluated by invasive FFR and coronary computed tomography angiography. High-risk attributes (HRA) were defined as high-risk physiological attribute (invasive FFR ≤0.8) and high-risk morphological attributes including: 1) local plaque burden (minimum lumen area <4 mm2 and plaque burden ≥70%); 2) adverse plaque characteristics ≥2; and 3) global plaque burden (total plaque volume ≥306.5 mm3 and percent atheroma volume ≥32.2%). The primary outcome was the composite of revascularization, myocardial infarction, or cardiac death at 5 years. Results: The mean FFR was 0.88 ± 0.08, and PCI was performed in 239 vessels. The primary outcome occurred in 54 vessels (6.2%). All high-risk morphological attributes were associated with the increased risk of adverse outcomes after adjustment for FFR ≤0.8 and demonstrated direct prognostic effect not mediated by FFR ≤0.8. The 5-year event risk proportionally increased as the number of HRA increased (p for trend <0.001) with lower risk in the PCI group than the medical treatment group in vessels with 1 or 2 HRA (9.7% vs. 14.7%), but not in vessels with either 0 or ≥3 HRA. Of the vessels with pre-procedural FFR ≤0.8, ischemia relief by PCI (pre-PCI FFR ≤0.8 and post-PCI FFR >0.8) significantly reduced vessel-oriented composite outcome risk compared with medical treatment alone in vessels with 0 or 1 high-risk morphological attributes (hazard ratio: 0.33; 95% confidence interval: 0.12 to 0.93; p = 0.035), but the risk reduction was attenuated in vessels with ≥2 high-risk morphological attributes.

KW - atherosclerosis

KW - coronary artery disease

KW - fractional flow reserve

KW - lesion-specific ischemia

KW - plaque characteristics

UR - http://www.scopus.com/inward/record.url?scp=85107317478&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2021.04.004

DO - 10.1016/j.jcmg.2021.04.004

M3 - Article

C2 - 34023270

AN - SCOPUS:85107317478

SN - 1936-878X

VL - 14

SP - 1977

EP - 1989

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 10

ER -

High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization

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Keywords

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