Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events

Christos V. Bourantas, Thomas Zanchin, Ryo Torii, Patrick W. Serruys, Alexios Karagiannis, Anantharaman Ramasamy, Hannah Safi, Ahmet Umit Coskun, Gerhard Koning, Yoshinobu Onuma, Christian Zanchin, Rob Krams, Anthony Mathur, Andreas Baumbach, Gary Mintz, Stephan Windecker, Alexandra Lansky, Akiko Maehara, Peter H. Stone, Lorenz RaberGregg W. Stone

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objectives: This study examined the value of endothelial shear stress (ESS) estimated in 3-dimensional quantitative coronary angiography (3D-QCA) models in detecting plaques that are likely to progress and cause events. Background: Cumulative evidence has shown that plaque characteristics and ESS derived from intravascular ultrasound (IVUS)−based reconstructions enable prediction of lesions that will cause cardiovascular events. However, the prognostic value of ESS estimated by 3D-QCA in nonflow limiting lesions is yet unclear. Methods: This study analyzed baseline virtual histology (VH)-IVUS and angiographic data from 28 lipid-rich lesions (i.e., fibroatheromas) that caused major adverse cardiovascular events or required revascularization (MACE-R) at 5-year follow-up and 119 lipid-rich plaques from a control group that remained quiescent. The segments studied by VH-IVUS at baseline were reconstructed using 3D-QCA software. In the obtained geometries, blood flow simulation was performed, and the pressure gradient across the lipid-rich plaque and the mean ESS values in 3-mm segments were estimated. The additive value of these hemodynamic indexes in predicting MACE-R beyond plaque characteristics was examined. Results: MACE-R lesions were longer, had smaller minimum lumen area, increased plaque burden (PB), were exposed to higher ESS, and exhibited a higher pressure gradient. In multivariable analysis, PB (hazard ratio: 1.08; p = 0.004) and the maximum 3-mm ESS value (hazard ratio: 1.11; p = 0.001) were independent predictors of MACE-R. Lesions exposed to high ESS (>4.95 Pa) with a high-risk anatomy (minimal lumen area <4 mm2 and PB >70%) had a higher MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS who had high- (20.0%) or low-risk anatomy (7.1%; p < 0.001). Conclusions: In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information, and, in combination with lesion anatomy, enabled more accurate identification of MACE-R lesions.

Original languageEnglish
Pages (from-to)2206-2219
Number of pages14
JournalJACC: Cardiovascular Imaging
Issue number10
StatePublished - Oct 2020
Externally publishedYes


  • quantitative coronary angiography
  • shear stress
  • vulnerable plaque


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