Journal of cardiovascular computed tomography · 2026
Disease progression and plaque composition in patients with non-obstructive coronary artery disease (THRONE): A coronary computed tomography angiography follow-up study.
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Mahmoud Karim D, Sharma Simran P, Budde Ricardo P J, Dedic Admir, Masdjedi Kaneshka, Lemmert Miguel E, Daemen Joost, Leipsic Jonathan A, de Windt Rafael J, Cummins Paul, Kardys Isabella, Leening Maarten J G, Hirsch Alexander, Van Mieghem Nicolas M
Аннотация
BACKGROUND: Fractional flow reserve (FFR)-negative coronary lesions are usually managed medically. Lesion-specific plaque characterization and FFR changes over time remain elusive.
AIMS: To assess disease progression in FFR-negative lesions over a two-year period using FFR derived from coronary CT angiography (CCTA) (FFRct) and to investigate whether FFR decline over a two-year period is associated with plaque characteristics.
METHODS: This single-center prospective study included patients undergoing coronary angiography with one or more invasive intermediate lesions (FFR 0.81-0.90) in non-stented, non-culprit coronary arteries. Two years after the index procedure, patients underwent CCTA with FFRct and quantitative plaque analysis.
RESULTS: We enrolled 131 patients (152 vessels). Two-year follow-up with FFRct and plaque analysis was available in 68 (52 %) patients (73 vessels). Compared to invasive FFR at baseline, FFRct at 2y follow-up was significantly lower (median difference -0.06) at vessel level analysis (p < 0.001). FFR declined in 55 (75 %) lesions. The 35 study vessels with an FFRct≤0.80 at 2-year follow-up had higher total percent atheroma volume (PAV) (41 % vs. 23 %; p = 0.002) and more high-risk plaque composition, including noncalcified PAV (30 % vs. 18 %; p = 0.002), and low-attenuation PAV (1.1 % vs. 0.7 %; p = 0.046) compared to vessels with an FFRct>0.80 (n = 38). Rates of study vessel revascularization in the 131 patients were 6.9 % at 2 years and 15.1 % after 4.9 years of follow-up after index procedure.
CONCLUSIONS: Rates of coronary revascularization are substantial in patients with medically managed intermediate lesions. In this selected cohort, an FFRct ≤0.80 at two-year follow-up was associated with higher plaque burden and presence of high-risk plaque composition.
AIMS: To assess disease progression in FFR-negative lesions over a two-year period using FFR derived from coronary CT angiography (CCTA) (FFRct) and to investigate whether FFR decline over a two-year period is associated with plaque characteristics.
METHODS: This single-center prospective study included patients undergoing coronary angiography with one or more invasive intermediate lesions (FFR 0.81-0.90) in non-stented, non-culprit coronary arteries. Two years after the index procedure, patients underwent CCTA with FFRct and quantitative plaque analysis.
RESULTS: We enrolled 131 patients (152 vessels). Two-year follow-up with FFRct and plaque analysis was available in 68 (52 %) patients (73 vessels). Compared to invasive FFR at baseline, FFRct at 2y follow-up was significantly lower (median difference -0.06) at vessel level analysis (p < 0.001). FFR declined in 55 (75 %) lesions. The 35 study vessels with an FFRct≤0.80 at 2-year follow-up had higher total percent atheroma volume (PAV) (41 % vs. 23 %; p = 0.002) and more high-risk plaque composition, including noncalcified PAV (30 % vs. 18 %; p = 0.002), and low-attenuation PAV (1.1 % vs. 0.7 %; p = 0.046) compared to vessels with an FFRct>0.80 (n = 38). Rates of study vessel revascularization in the 131 patients were 6.9 % at 2 years and 15.1 % after 4.9 years of follow-up after index procedure.
CONCLUSIONS: Rates of coronary revascularization are substantial in patients with medically managed intermediate lesions. In this selected cohort, an FFRct ≤0.80 at two-year follow-up was associated with higher plaque burden and presence of high-risk plaque composition.