Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography

doi:10.4244/eij-d-22-00562

Coronary disease & ACS

Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography

EuroInterventionPublished 23 Jan 2023Cohort study

Main finding · VOCOResultHazard ratio 8.36 95% CI 2.86–24.44

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Authors' conclusion

In non-ischaemic lesions, ql-HRP and qn-HRP showed a synergistic impact on risk assessment and had prognostic interactions with FFR and treatment modalities.

Study context

Population: Patients undergoing fractional flow reserve (FFR)-guided treatment, non-ischaemic coronary lesions assessed by coronary CT angiography
Participants: 458 patients697 vessels

Exposure: Lesions with quantitative high-risk plaque (qn-HRP) and/or qualitative HRP (ql-HRP) on coronary CT angiography vs lesions without; Percutaneous coronary intervention (PCI) vs medical treatment
Outcome: Vessel-oriented composite outcome (VOCO:
Cardiac death
MI
Revascularisation)

Methodological detailsMean baseline FFR 0.85±0.12; 25.8% underwent PCI during the index procedure

Mean baseline FFR 0.85±0.12; 25.8% underwent PCI during the index procedure

Main finding

VOCO

Hazard ratio

8.36

95% CI 2.86–24.44

qn-HRP(+)/ql-HRP(+)vs qn-HRP(-)/ql-HRP(-)

HR 8.36 (95% CI 2.86–24.44)

As reported in the abstract

In medically treated lesions, both qn-HRP and ql-HRP associated with increased risk of vessel-oriented composite outcome (VOCO): P < 0.05

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with PCI ←→ Higher risk with PCI →	HR (95% CI)
VOCO, PCIvs medical treatment in qn-HRP(+)/ql-HRP(+) lesions	0.050.21520	0.31 (0.11–0.91)
VOCO, PCIvs medical treatment in qn-HRP(+)/ql-HRP(+) lesions, by FFR (subgroup)FFR 0.81-0.90	0.050.21520	0.19 (0.04–0.90)
	0.050.21520Hazard ratio (log scale)

VOCO, PCI vs medical treatment in qn-HRP(+)/ql-HRP(+) lesions, by FFR (subgroup)

Difference not consistent in lesions with FFR >0.90

Original publication

Outcomes of non-ischaemic coronary lesions with high-risk plaque characteristics on coronary CT angiography. EuroIntervention. Published 23 January 2023. doi:10.4244/eij-d-22-00562

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