Cited 18 times in
High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization
DC Field | Value | Language |
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dc.contributor.author | 장혁재 | - |
dc.date.accessioned | 2022-03-11T05:51:36Z | - |
dc.date.available | 2022-03-11T05:51:36Z | - |
dc.date.issued | 2021-10 | - |
dc.identifier.issn | 1936-878X | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/187834 | - |
dc.description.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. Conclusions: High-risk morphological attributes offered additive prognostic value to coronary physiology and may optimize selection of treatment strategies by adding to FFR-based risk predictions (CCTA-FFR Registry for Development of Comprehensive Risk Prediction Model; NCT04037163). | - |
dc.description.statementOfResponsibility | restriction | - |
dc.language | English | - |
dc.publisher | Elsevier | - |
dc.relation.isPartOf | JACC-CARDIOVASCULAR IMAGING | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Coronary Angiography | - |
dc.subject.MESH | Coronary Artery Disease* / diagnostic imaging | - |
dc.subject.MESH | Coronary Artery Disease* / therapy | - |
dc.subject.MESH | Fractional Flow Reserve, Myocardial* | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Percutaneous Coronary Intervention* / adverse effects | - |
dc.subject.MESH | Predictive Value of Tests | - |
dc.title | High-Risk Morphological and Physiological Coronary Disease Attributes as Outcome Markers After Medical Treatment and Revascularization | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Internal Medicine (내과학교실) | - |
dc.contributor.googleauthor | Seokhun Yang | - |
dc.contributor.googleauthor | Bon-Kwon Koo | - |
dc.contributor.googleauthor | Doyeon Hwang | - |
dc.contributor.googleauthor | Jinlong Zhang | - |
dc.contributor.googleauthor | Masahiro Hoshino | - |
dc.contributor.googleauthor | Joo Myung Lee | - |
dc.contributor.googleauthor | Tadashi Murai | - |
dc.contributor.googleauthor | Jiesuck Park | - |
dc.contributor.googleauthor | Eun-Seok Shin | - |
dc.contributor.googleauthor | Joon-Hyung Doh | - |
dc.contributor.googleauthor | Chang-Wook Nam | - |
dc.contributor.googleauthor | Jianan Wang | - |
dc.contributor.googleauthor | Shaoliang Chen | - |
dc.contributor.googleauthor | Nobuhiro Tanaka | - |
dc.contributor.googleauthor | Hitoshi Matsuo | - |
dc.contributor.googleauthor | Takashi Akasaka | - |
dc.contributor.googleauthor | Hyuk-Jae Chang | - |
dc.contributor.googleauthor | Tsunekazu Kakuta | - |
dc.contributor.googleauthor | Jagat Narula | - |
dc.identifier.doi | 10.1016/j.jcmg.2021.04.004 | - |
dc.contributor.localId | A03490 | - |
dc.relation.journalcode | J01192 | - |
dc.identifier.eissn | 1876-7591 | - |
dc.identifier.pmid | 34023270 | - |
dc.identifier.url | https://www.sciencedirect.com/science/article/pii/S1936878X2100348X | - |
dc.subject.keyword | atherosclerosis | - |
dc.subject.keyword | coronary artery disease | - |
dc.subject.keyword | fractional flow reserve | - |
dc.subject.keyword | lesion-specific ischemia | - |
dc.subject.keyword | plaque characteristics | - |
dc.contributor.alternativeName | Chang, Hyuck Jae | - |
dc.contributor.affiliatedAuthor | 장혁재 | - |
dc.citation.volume | 14 | - |
dc.citation.number | 10 | - |
dc.citation.startPage | 1977 | - |
dc.citation.endPage | 1989 | - |
dc.identifier.bibliographicCitation | JACC-CARDIOVASCULAR IMAGING, Vol.14(10) : 1977-1989, 2021-10 | - |
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