TCT-349 Anatomical versus physiological lesion characteristics in prediction of acute coronary syndrome.

Abstract

Background: The comparative effectiveness between anatomy- and physiology-based acute coronary syndrome (ACS) risk assessment has not been fully defined. Method(s): This international, multicenter, internal case-control study enrolled 351 patients undergoing coronary computed tomography angiography (CCTA) and experiencing ACS between 1 month and 3 years later after medical follow-up. The lesions on CCTA were adjudicated to culprit and nonculprit lesions according to the invasive coronary angiography at the ACS event. Core laboratory CCTA analyses revealed 4 lesion-specific anatomical and physiological characteristics: the degree of stenosis, the number of adverse plaque characteristics, plaque burden at minimum lumen area, and changes in CCTA-derived fractional flow reserve across the lesion (DELTAFFRCT). Result(s): Among the total of 2,451 lesions defined on CCTA, 363 lesions (14.8%) became the culprit of ACS with a median interval of 375 days. Four anatomical and physiological lesion characteristics showed a direct association with ACS culprit risk, not mediated by other characteristics (all P < 0.001). In identifying ACS culprit lesions, plaque burden >=70% showed the highest sensitivity of 90.6% (87.2%-93.2%), and DELTAFFRCT >=0.10 had the highest specificity of 88.3% (86.9%-89.6%). The predictability was similar between DELTAFFRCT and the combined other anatomical characteristics (AUC: 0.805 vs 0.802; P = 0.778), with additive discrimination toward each other (Figure). [Formula presented] Conclusion(s): Luminal narrowing, plaque quality and quantity, and local hemodynamics were independent predictors of ACS, offering specificity in physiology and sensitivity in anatomy. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024