Predictive value of plaque characteristics assessed by coronary computed tomography angiography and optical coherence tomography for identification of lesions causing ischemia

Abstract

Background and Aim: In patients with intermediate coronary stenosis, the functional assessment with fractional flow reserve (FFR) and the anatomical assessment with optical coherence tomography (OCT) have been widely used in clinical practice. In addition, coronary computed tomography angiography (CTA) is commonly used non-invasive imaging technique for evaluating suspected coronary artery disease before being referred for coronary angiography. This study sought to investigate the association between FFR and plaque characteristics assessed by coronary CTA and OCT in patients with intermediate coronary stenosis. Methods: Based on the prospective multicenter registry, a total of 159 patients including 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography and both FFR measurement and OCT examination were performed during angiography. The stenotic lesion with FFR ≤0.80 was considered diagnostic of lesion causing ischemia. The predictive value of plaque characteristics assessed by coronary CTA and OCT for identifying lesions causing ischemia was analyzed. Results: Plaque characteristics on coronary CTA and OCT were different between the lesions causing ischemia versus not causing ischemia. On multivariate analysis, quantitative degree of stenosis on coronary CTA and OCT were independent predictors for the lesions causing ischemia, and OCT had a trend for higher predictive value than that of coronary CTA. In addition, qualitative characteristics including low attenuation plaque on coronary CTA and thrombus, intimal vasculature, and plaque rupture on OCT were also independent predictors for the lesions causing ischemia. Increasing number of these qualitative characteristics offered incremental improvement in predicting the lesions causing ischemia. Conclusion: The results from this study suggest that comprehensive anatomical evaluation of coronary stenosis may be able to provide additional supportive information for predicting the lesions causing ischemia.