Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

Jiesuck Park; Joo Myung Lee; Bon Kwon Koo; Gilwoo Choi; Doyeon Hwang; Tae Min Rhee; Seokhun Yang; Jonghanne Park; Jinlong Zhang; Kyung Jin Kim; Yaliang Tong; Joon Hyung Doh; Chang Wook Nam; Eun Seok Shin; Young Seok Cho; Eun Ju Chun; Jin Ho Choi; Bjarne L. Norgaard; Evald H. Christiansen; Koen Niemen; Hiromasa Otake; Martin Penicka; Bernard de Bruyne; Takashi Kubo; Takashi Akasaka; Jagat Narula; Pamela S. Douglas; Charles A. Taylor

doi:10.1007/s00330-019-06221-9

Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

Jiesuck Park, Joo Myung Lee, Bon Kwon Koo, Gilwoo Choi, Doyeon Hwang, Tae Min Rhee, Seokhun Yang, Jonghanne Park, Jinlong Zhang, Kyung Jin Kim, Yaliang Tong, Joon Hyung Doh, Chang Wook Nam, Eun Seok Shin, Young Seok Cho, Eun Ju Chun, Jin Ho Choi, Bjarne L. Norgaard, Evald H. Christiansen, Koen NiemenHiromasa Otake, Martin Penicka, Bernard de Bruyne, Takashi Kubo, Takashi Akasaka, Jagat Narula, Pamela S. Douglas, Charles A. Taylor

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

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Abstract

Objectives: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). Methods: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. Results: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFR_CT across the lesion (ΔFFR_CT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFR_CT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050–0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027–0.029) and plaque volume (0.023, 95% CI 0.022–0.024). Lesions with higher ΔFFR_CT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31–8.04, p = 0.010 for ΔFFR_CT; HR 2.60, 95% CI 1.36–4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFR_CT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724–0.727). Conclusion: Non-obstructive lesions with higher ΔFFR_CT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. Key Points: • Change in FFR_CTacross the lesion (ΔFFR_CT) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFR_CTor low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.

Original language	English
Pages (from-to)	6119-6128
Number of pages	10
Journal	European Radiology
Volume	29
Issue number	11
DOIs	https://doi.org/10.1007/s00330-019-06221-9
State	Published - 1 Nov 2019

Keywords

Acute coronary syndrome
Computed tomography angiography
Coronary stenosis
Hemodynamics
Plaque, atherosclerotic

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10.1007/s00330-019-06221-9

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Park, J., Lee, J. M., Koo, B. K., Choi, G., Hwang, D., Rhee, T. M., Yang, S., Park, J., Zhang, J., Kim, K. J., Tong, Y., Doh, J. H., Nam, C. W., Shin, E. S., Cho, Y. S., Chun, E. J., Choi, J. H., Norgaard, B. L., Christiansen, E. H., ... Taylor, C. A. (2019). Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome. European Radiology, 29(11), 6119-6128. https://doi.org/10.1007/s00330-019-06221-9

@article{b42e27c485414b03a276e7f63a1a0e97,

title = "Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome",

abstract = "Objectives: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). Methods: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. Results: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050–0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027–0.029) and plaque volume (0.023, 95% CI 0.022–0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31–8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36–4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724–0.727). Conclusion: Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. Key Points: • Change in FFRCTacross the lesion (ΔFFRCT) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFRCTor low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.",

keywords = "Acute coronary syndrome, Computed tomography angiography, Coronary stenosis, Hemodynamics, Plaque, atherosclerotic",

author = "Jiesuck Park and Lee, {Joo Myung} and Koo, {Bon Kwon} and Gilwoo Choi and Doyeon Hwang and Rhee, {Tae Min} and Seokhun Yang and Jonghanne Park and Jinlong Zhang and Kim, {Kyung Jin} and Yaliang Tong and Doh, {Joon Hyung} and Nam, {Chang Wook} and Shin, {Eun Seok} and Cho, {Young Seok} and Chun, {Eun Ju} and Choi, {Jin Ho} and Norgaard, {Bjarne L.} and Christiansen, {Evald H.} and Koen Niemen and Hiromasa Otake and Martin Penicka and {de Bruyne}, Bernard and Takashi Kubo and Takashi Akasaka and Jagat Narula and Douglas, {Pamela S.} and Taylor, {Charles A.}",

note = "Publisher Copyright: {\textcopyright} 2019, European Society of Radiology.",

year = "2019",

month = nov,

day = "1",

doi = "10.1007/s00330-019-06221-9",

language = "English",

volume = "29",

pages = "6119--6128",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "11",

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Park, J, Lee, JM, Koo, BK, Choi, G, Hwang, D, Rhee, TM, Yang, S, Park, J, Zhang, J, Kim, KJ, Tong, Y, Doh, JH, Nam, CW, Shin, ES, Cho, YS, Chun, EJ, Choi, JH, Norgaard, BL, Christiansen, EH, Niemen, K, Otake, H, Penicka, M, de Bruyne, B, Kubo, T, Akasaka, T, Narula, J, Douglas, PS & Taylor, CA 2019, 'Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome', European Radiology, vol. 29, no. 11, pp. 6119-6128. https://doi.org/10.1007/s00330-019-06221-9

TY - JOUR

T1 - Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

AU - Park, Jiesuck

AU - Lee, Joo Myung

AU - Koo, Bon Kwon

AU - Choi, Gilwoo

AU - Hwang, Doyeon

AU - Rhee, Tae Min

AU - Yang, Seokhun

AU - Park, Jonghanne

AU - Zhang, Jinlong

AU - Kim, Kyung Jin

AU - Tong, Yaliang

AU - Doh, Joon Hyung

AU - Nam, Chang Wook

AU - Shin, Eun Seok

AU - Cho, Young Seok

AU - Chun, Eun Ju

AU - Choi, Jin Ho

AU - Norgaard, Bjarne L.

AU - Christiansen, Evald H.

AU - Niemen, Koen

AU - Otake, Hiromasa

AU - Penicka, Martin

AU - de Bruyne, Bernard

AU - Kubo, Takashi

AU - Akasaka, Takashi

AU - Narula, Jagat

AU - Douglas, Pamela S.

AU - Taylor, Charles A.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objectives: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). Methods: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. Results: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050–0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027–0.029) and plaque volume (0.023, 95% CI 0.022–0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31–8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36–4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724–0.727). Conclusion: Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. Key Points: • Change in FFRCTacross the lesion (ΔFFRCT) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFRCTor low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.

AB - Objectives: We explored the anatomical, plaque, and hemodynamic characteristics of high-risk non-obstructive coronary lesions that caused acute coronary syndrome (ACS). Methods: From the EMERALD study which included ACS patients with available coronary CT angiography (CCTA) before the ACS, non-obstructive lesions (percent diameter stenosis < 50%) were selected. CCTA images were analyzed for lesion characteristics by independent CCTA and computational fluid dynamics core laboratories. The relative importance of each characteristic was assessed by information gain. Results: Of the 132 lesions, 24 were the culprit for ACS. The culprit lesions showed a larger change in FFRCT across the lesion (ΔFFRCT) than non-culprit lesions (0.08 ± 0.07 vs 0.05 ± 0.05, p = 0.012). ΔFFRCT showed the highest information gain (0.051, 95% confidence interval [CI] 0.050–0.052), followed by low-attenuation plaque (0.028, 95% CI 0.027–0.029) and plaque volume (0.023, 95% CI 0.022–0.024). Lesions with higher ΔFFRCT or low-attenuation plaque showed an increased risk of ACS (hazard ratio [HR] 3.25, 95% CI 1.31–8.04, p = 0.010 for ΔFFRCT; HR 2.60, 95% CI 1.36–4.95, p = 0.004 for low-attenuation plaque). The prediction model including ΔFFRCT, low-attenuation plaque and plaque volume showed the highest ability in ACS prediction (AUC 0.725, 95% CI 0.724–0.727). Conclusion: Non-obstructive lesions with higher ΔFFRCT or low-attenuation plaque showed a higher risk of ACS. The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk in non-obstructive lesions. Key Points: • Change in FFRCTacross the lesion (ΔFFRCT) was the most important predictor of ACS risk in non-obstructive lesions. • Non-obstructive lesions with higher ΔFFRCTor low-attenuation plaque were associated with a higher risk of ACS. • The integration of anatomical, plaque, and hemodynamic characteristics can improve the noninvasive prediction of ACS risk.

KW - Acute coronary syndrome

KW - Computed tomography angiography

KW - Coronary stenosis

KW - Hemodynamics

KW - Plaque, atherosclerotic

UR - http://www.scopus.com/inward/record.url?scp=85065017636&partnerID=8YFLogxK

U2 - 10.1007/s00330-019-06221-9

DO - 10.1007/s00330-019-06221-9

M3 - Article

C2 - 31025066

AN - SCOPUS:85065017636

SN - 0938-7994

VL - 29

SP - 6119

EP - 6128

JO - European Radiology

JF - European Radiology

IS - 11

ER -

Relevance of anatomical, plaque, and hemodynamic characteristics of non-obstructive coronary lesions in the prediction of risk for acute coronary syndrome

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Keywords

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