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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

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dc.description.abstractImportance: 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.-
dc.publisherAmerican Medical Association-
dc.relation.isPartOfJAMA CARDIOLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.subject.MESHAcute Coronary Syndrome* / diagnostic imaging-
dc.subject.MESHAcute Coronary Syndrome* / etiology-
dc.subject.MESHCase-Control Studies-
dc.subject.MESHCoronary Angiography / methods-
dc.subject.MESHMiddle Aged-
dc.subject.MESHPlaque, Atherosclerotic* / complications-
dc.subject.MESHPlaque, Atherosclerotic* / diagnostic imaging-
dc.subject.MESHRetrospective Studies-
dc.titleAssociation of Plaque Location and Vessel Geometry Determined by Coronary Computed Tomographic Angiography With Future Acute Coronary Syndrome-Causing Culprit Lesions-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학교실)-
dc.contributor.googleauthorDonghee Han-
dc.contributor.googleauthorAndrew Lin-
dc.contributor.googleauthorKeiichiro Kuronuma-
dc.contributor.googleauthorEvangelos Tzolos-
dc.contributor.googleauthorAlan C Kwan-
dc.contributor.googleauthorEyal Klein-
dc.contributor.googleauthorDaniele Andreini-
dc.contributor.googleauthorJeroen J Bax-
dc.contributor.googleauthorFilippo Cademartiri-
dc.contributor.googleauthorKavitha Chinnaiyan-
dc.contributor.googleauthorBenjamin J W Chow-
dc.contributor.googleauthorEdoardo Conte-
dc.contributor.googleauthorRicardo C Cury-
dc.contributor.googleauthorGudrun Feuchtner-
dc.contributor.googleauthorMartin Hadamitzky-
dc.contributor.googleauthorYong-Jin Kim-
dc.contributor.googleauthorJonathon A Leipsic-
dc.contributor.googleauthorErica Maffei-
dc.contributor.googleauthorHugo Marques-
dc.contributor.googleauthorFabian Plank-
dc.contributor.googleauthorGianluca Pontone-
dc.contributor.googleauthorTodd C Villines-
dc.contributor.googleauthorMouaz H Al-Mallah-
dc.contributor.googleauthorPedro de Araújo Gonçalves-
dc.contributor.googleauthorIbrahim Danad-
dc.contributor.googleauthorHeidi Gransar-
dc.contributor.googleauthorYao Lu-
dc.contributor.googleauthorJi-Hyun Lee-
dc.contributor.googleauthorSang-Eun Lee-
dc.contributor.googleauthorLohendran Baskaran-
dc.contributor.googleauthorSubhi J Al'Aref-
dc.contributor.googleauthorYeonyee E Yoon-
dc.contributor.googleauthorAlexander Van Rosendael-
dc.contributor.googleauthorMatthew J Budoff-
dc.contributor.googleauthorHabib Samady-
dc.contributor.googleauthorPeter H Stone-
dc.contributor.googleauthorRenu Virmani-
dc.contributor.googleauthorStephan Achenbach-
dc.contributor.googleauthorJagat Narula-
dc.contributor.googleauthorHyuk-Jae Chang-
dc.contributor.googleauthorJames K Min-
dc.contributor.googleauthorFay Y Lin-
dc.contributor.googleauthorLeslee J Shaw-
dc.contributor.googleauthorPiotr J Slomka-
dc.contributor.googleauthorDamini Dey-
dc.contributor.googleauthorDaniel S Berman-
dc.contributor.alternativeNameChang, Hyuck Jae-
dc.identifier.bibliographicCitationJAMA CARDIOLOGY, Vol.7(3) : 309-319, 2022-03-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers


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