Association of Hemodynamic Disease Severity and Distribution With Risk of Future Acute Coronary Syndrome.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Yang Seokhun, Chung Jae Wook, Park Sang-Hyeon, Zhang Jinlong, Lee Keehwan, Hwang Doyeon, Lee Kyu-Sun, Na Sang-Hoon, Doh Joon-Hyung, Nam Chang-Wook, Kim Tae Hyun, Shin Eun-Seok, Chun Eun Ju, Choi Su-Yeon, Kim Hyun Kuk, Hong Young Joon, Park Hun-Jun, Kim Song-Yi, Husic Mirza, Lambrechtsen Jess, Jensen Jesper M, Nørgaard Bjarne L, Andreini Daniele, Maurovich-Horvat Pal, Merkely Bela, Penicka Martin, de Bruyne Bernard, Ihdayhid Abdul, Ko Brian, Tzimas Georgios, Sanz Javier, Rabbat Mark G, Katchi Farhan, Shah Moneal, Tanaka Nobuhiro, Nakazato Ryo, Asano Taku, Terashima Mitsuyasu, Takashima Hiroaki, Amano Tetsuya, Sobue Yoshihiro, Matsuo Hitoshi, Otake Hiromasa, Kubo Takashi, Takahata Masahiro, Akasaka Takashi, Kido Teruhito, Mochizuki Teruhito, Yokoi Hiroyoshi, Okonogi Taichi, Kawasaki Tomohiro, Nakao Koichi, Sakamoto Tomohiro, Yonetsu Taishi, Kakuta Tsunekazu, Yamauchi Yohei, Taylor Charles A, Bax Jeroen J, Shaw Leslee J, Stone Peter H, Narula Jagat, Leipsic Jonathon, Koo Bon-Kwon
Аннотация
OBJECTIVES: This study aims to investigate the independent and combined prognostic significance of hemodynamic disease severity and distribution in identifying ACS culprit vessels, in conjunction with lumen and plaque characteristics.
METHODS: The EMERALD-II study is an international, multicenter, internal case-control study enrolling 351 patients with ACS who underwent coronary computed tomography angiography (CTA) 1 month to 3 years before the event. Culprit and nonculprit vessels were identified by matching invasive coronary angiography with coronary CTA findings. High-risk plaque (HRP) characteristics, including minimum lumen area <4 mm2, plaque burden ≥70%, low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign, were assessed by a core laboratory, with HRP defined as ≥3 HRP characteristics. From coronary CTA, the authors derived both the hemodynamic severity of the disease (fractional flow reserve derived from computed tomography [FFRCT]) and its spatial distribution (diffuse vs focal), as assessed by the pullback pressure gradient derived from coronary CTA (PPGCT). Vessels were categorized into 4 hemodynamic disease patterns: nonischemic (FFRCT >0.80), hemodynamic diffuse (FFRCT ≤0.80 and PPGCT ≤0.50), mixed (FFRCT ≤0.80 and 0.50 < PPGCT ≤0.60), and focal disease (FFRCT ≤0.80 and PPGCT >0.60).
RESULTS: Among 873 vessels, the mean FFRCT was 0.74 ± 0.17 and the mean PPGCT was 0.54 ± 0.14. Both lower FFRCT and higher PPGCT were independently associated with higher ACS risk (OR per 0.1 increase in FFRCT: 0.71 [95% CI: 0.65-0.77]; P < 0.001; OR per 0.1 increase in PPG: 1.22 [95% CI: 1.09-1.37]; P < 0.001). Among the 4 subgroups of hemodynamic disease pattern, hemodynamic focal disease showed the highest risk of ACS (relative risk [RR]: 2.02 [95% CI: 1.74-2.36]; P < 0.001), myocardial infarction (RR: 1.75 [95% CI: 1.43-2.14]; P < 0.001), and unstable angina (RR: 2.54 [95% CI: 2.00-3.22]; P < 0.001). It remained a predictor for ACS in nonobstructive lesions (OR: 3.56 [95% CI: 1.43-8.84]), obstructive lesions (OR: 3.16 [95% CI: 1.96-5.07]), non-HRP (OR: 6.69 [95% CI: 3.59-12.5]), and HRP (OR: 2.98 [95% CI: 1.83-4.87]). Although the maximal lesion-level ΔFFRCT (differences in FFRCT across the lesion) demonstrated superior model performance compared with models incorporating FFRCT and PPGCT, higher PPGCT was additionally associated with increased ACS risk, particularly among vessels with maximal ΔFFRCT ≥0.10.
CONCLUSIONS: Hemodynamic disease distribution, as measured by PPGCT, complements FFRCT in predicting ACS risk. The integration of hemodynamic disease patterns provides additional prognostic value beyond lumen and plaque characteristics, with hemodynamic focal disease emerging as an independent predictor and a potential therapeutic target for ACS prevention. (Exploring the Mechanism of Plaque Rupture in Acute Coronary Syndrome Using Coronary CT Angiography and Computational Fluid Dynamics II [EMERALD II]; NCT03591328).