Prognostic Implications of Comprehensive Whole Vessel Plaque Quantification Using Coronary Computed Tomography Angiography
Seokhun Yang, MD,
Joo Myung Lee, MD, MPH, PhD,
Masahiro Hoshino, MD,
Tadashi Murai, MD, PhD,
Ki Hong Choi, MD,
Doyeon Hwang, MD,
Kyung-Jin Kim, MD,
Eun-Seok Shin, MD, PhD,
Joon-Hyung Doh, MD, PhD,
Hyuk-Jae Chang, MD, PhD,
Chang-Wook Nam, MD, PhD,
Jinlong Zhang, MD,
Jianan Wang, MD, PhD,
Shao-Liang Chen, MD, PhD,
Nobuhiro Tanaka, MD, PhD,
Hitoshi Matsuo, MD, PhD,
Takashi Akasaka, MD, PhD,
Tsunekazu Kakuta, MD, PhD,
Bon-Kwon Koo, MD, PhD
Affiliations
Seokhun Yang, MD
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
Joo Myung Lee, MD, MPH, PhD
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Masahiro Hoshino, MD
Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
Tadashi Murai, MD, PhD
Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
Ki Hong Choi, MD
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Doyeon Hwang, MD
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
Kyung-Jin Kim, MD
Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
Eun-Seok Shin, MD, PhD
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea and Division of Cardiology, Ulsan Hospital, Ulsan, Korea
Joon-Hyung Doh, MD, PhD
Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
Hyuk-Jae Chang, MD, PhD
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea
Chang-Wook Nam, MD, PhD
Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
Jinlong Zhang, MD
Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
Jianan Wang, MD, PhD
Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
Shao-Liang Chen, MD, PhD
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
Nobuhiro Tanaka, MD, PhD
Department of Cardiology, Tokyo Medical University, Tokyo, Japan
Hitoshi Matsuo, MD, PhD
Department of Cardiology, Gifu Heart Center, Gifu, Japan
Takashi Akasaka, MD, PhD
Wakayama Medical University, Wakayama, Japan
Tsunekazu Kakuta, MD, PhD
Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
Bon-Kwon Koo, MD, PhD
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute on Aging, Seoul National University, Seoul, Korea; Address for correspondence: Dr Bon-Kwon Koo, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, 101 Daehang-ro, Chongno-gu, Seoul 110-744, Korea.
Background: The prognostic value of whole vessel plaque quantification has not been fully understood. Objectives: We aimed to investigate the clinical relevance of whole vessel plaque quantification on coronary computed tomography angiography. Methods: In a total of 1,013 vessels with fractional flow reserve (FFR) measurement and available coronary computed tomography angiography, high-risk plaque characteristics (HRPC) included minimum lumen area 0.80, the number of HRVC was significantly associated with the risk of VOCO (HR: 2.54; 95% CI: 1.77-3.64) and enhanced the predictability for VOCO of % diameter stenosis and the number of HRPC (P < 0.001). In a landmark analysis at 2 years, the number of HRVC showed sustained prognostic implications beyond 2 years, but the number of HRPC did not. Conclusions: Whole vessel plaque quantification can provide incremental predictability for low FFR and additive prognostic value in deferred vessels with high FFR over anatomical severity and lesion plaque characteristics. (CCTA-FFR Registry for Risk Prediction; NCT04037163)
