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Association of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome-Causing Culprit Lesions

Authors
 Donghee Han  ;  Andrew Lin  ;  Keiichiro Kuronuma  ;  Evangelos Tzolos  ;  Alan C Kwan  ;  Eyal Klein  ;  Daniele Andreini  ;  Jeroen J Bax  ;  Filippo Cademartiri  ;  Kavitha Chinnaiyan  ;  Benjamin J W Chow  ;  Edoardo Conte  ;  Ricardo C Cury  ;  Gudrun Feuchtner  ;  Martin Hadamitzky  ;  Yong-Jin Kim  ;  Jonathon A Leipsic  ;  Erica Maffei  ;  Hugo Marques  ;  Fabian Plank  ;  Gianluca Pontone  ;  Todd C Villines  ;  Mouaz H Al-Mallah  ;  Pedro de Araújo Gonçalves  ;  Ibrahim Danad  ;  Heidi Gransar  ;  Yao Lu  ;  Ji-Hyun Lee  ;  Sang-Eun Lee  ;  Lohendran Baskaran  ;  Subhi J Al'Aref  ;  Yeonyee E Yoon  ;  Alexander Van Rosendael  ;  Matthew J Budoff  ;  Habib Samady  ;  Peter H Stone  ;  Renu Virmani  ;  Stephan Achenbach  ;  Jagat Narula  ;  Hyuk-Jae Chang  ;  James K Min  ;  Fay Y Lin  ;  Leslee J Shaw  ;  Piotr J Slomka  ;  Damini Dey  ;  Daniel S Berman 
Citation
 JAMA CARDIOLOGY, Vol.7(3) : 309-319, 2022-03 
Journal Title
JAMA CARDIOLOGY
ISSN
 2380-6583 
Issue Date
2022-03
MeSH
Acute Coronary Syndrome* / diagnostic imaging ; Acute Coronary Syndrome* / etiology ; Case-Control Studies ; Coronary Angiography / methods ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic* / complications ; Plaque, Atherosclerotic* / diagnostic imaging ; Retrospective Studies
Abstract
Importance: Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown.

Objective: To examine whether CCTA-derived adverse geometric characteristics (AGCs) of coronary lesions describing location and vessel geometry add to plaque morphology and burden for identifying culprit lesion precursors associated with future ACS.

Design, setting, and participants: This substudy of ICONIC (Incident Coronary Syndromes Identified by Computed Tomography), a multicenter nested case-control cohort study, included patients with ACS and a culprit lesion precursor identified on baseline CCTA (n = 116) and propensity score-matched non-ACS controls (n = 116). Data were collected from July 20, 2012, to April 30, 2017, and analyzed from October 1, 2020, to October 31, 2021.

Exposures: Coronary lesions were evaluated for the following 3 AGCs: (1) distance from the coronary ostium to lesion; (2) location at vessel bifurcations; and (3) vessel tortuosity, defined as the presence of 1 bend of greater than 90° or 3 curves of 45° to 90° using a 3-point angle within the lesion.

Main outcomes and measures: Association between lesion-level AGCs and risk of future ACS-causing culprit lesions.

Results: Of 548 lesions, 116 culprit lesion precursors were identified in 116 patients (80 [69.0%] men; mean [SD], age 62.7 [11.5] years). Compared with nonculprit lesions, culprit lesion precursors had a shorter distance from the ostium (median, 35.1 [IQR, 23.6-48.4] mm vs 44.5 [IQR, 28.2-70.8] mm), more frequently localized to bifurcations (85 [73.3%] vs 168 [38.9%]), and had more tortuous vessel segments (5 [4.3%] vs 6 [1.4%]; all P < .05). In multivariable Cox regression analysis, an increasing number of AGCs was associated with a greater risk of future culprit lesions (hazard ratio [HR] for 1 AGC, 2.90 [95% CI, 1.38-6.08]; P = .005; HR for ≥2 AGCs, 6.84 [95% CI, 3.33-14.04]; P < .001). Adverse geometric characteristics provided incremental discriminatory value for culprit lesion precursors when added to a model containing stenosis severity, adverse morphological plaque characteristics, and quantitative plaque characteristics (area under the curve, 0.766 [95% CI, 0.718-0.814] vs 0.733 [95% CI, 0.685-0.782]). In per-patient comparison, patients with ACS had a higher frequency of lesions with adverse plaque characteristics, AGCs, or both compared with control patients (≥2 adverse plaque characteristics, 70 [60.3%] vs 50 [43.1%]; ≥2 AGCs, 92 [79.3%] vs 60 [51.7%]; ≥2 of both, 37 [31.9%] vs 20 [17.2%]; all P < .05).

Conclusions and relevance: These findings support the concept that CCTA-derived AGCs capturing lesion location and vessel geometry are associated with risk of future ACS-causing culprit lesions. Adverse geometric characteristics may provide additive prognostic information beyond plaque assessment in CCTA.
Full Text
https://jamanetwork.com/journals/jamacardiology/fullarticle/2788006
DOI
10.1001/jamacardio.2021.5705
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188325
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