Abstract：
BACKGROUND: Functional assessment using fractional flow reserve (FFR) and anatomical assessment using optical coherence tomography (OCT) are used in clinical practice for patients with intermediate coronary stenosis. Moreover, coronary computed tomography angiography (CTA) is a common noninvasive imaging technique for evaluating suspected coronary artery disease before being referred for angiography. This study aimed to investigate the association between FFR and plaque characteristics assessed using coronary CTA and OCT for intermediate coronary stenosis.
METHODS: Based on a prospective multicenter registry, 159 patients having 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography, and both FFR measurements and OCT examinations were performed during angiography. A stenotic lesion identified with FFR ≤0.80 was deemed diagnostic of an ischemia-causing lesion. The predictive value of plaque characteristics assessed using coronary CTA and OCT for identifying lesions causing ischemia was analyzed.
RESULTS: Stenosis severity and plaque characteristics on coronary CTA and OCT differed between lesions that caused ischemia and those that did not. In multivariate analysis, low attenuation plaque on coronary CTA (odds ratio [OR]=2.78; P=0.038), thrombus (OR=5.13; P=0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors of ischemic lesions. Increasing the number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia.
CONCLUSIONS: Comprehensive anatomical evaluation of coronary stenosis may provide additional supportive information for predicting the lesions causing ischemia.
METHODS: Based on a prospective multicenter registry, 159 patients having 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography, and both FFR measurements and OCT examinations were performed during angiography. A stenotic lesion identified with FFR ≤0.80 was deemed diagnostic of an ischemia-causing lesion. The predictive value of plaque characteristics assessed using coronary CTA and OCT for identifying lesions causing ischemia was analyzed.
RESULTS: Stenosis severity and plaque characteristics on coronary CTA and OCT differed between lesions that caused ischemia and those that did not. In multivariate analysis, low attenuation plaque on coronary CTA (odds ratio [OR]=2.78; P=0.038), thrombus (OR=5.13; P=0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors of ischemic lesions. Increasing the number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia.
CONCLUSIONS: Comprehensive anatomical evaluation of coronary stenosis may provide additional supportive information for predicting the lesions causing ischemia.
摘要：
背景：使用血流储备分数（FFR）的功能评估和使用光学相干断层扫描（OCT）的解剖评估在临床实践中用于中度冠状动脉狭窄患者。此外，冠状动脉计算机断层扫描血管造影(CTA)是一种常见的非侵入性成像技术,用于在进行血管造影之前评估可疑的冠状动脉疾病.本研究旨在探讨使用冠状动脉CTA和OCT评估中度冠状动脉狭窄的FFR与斑块特征之间的关系。
方法：基于前瞻性多中心注册，纳入了159例具有339个中度狭窄的冠状动脉病变的患者。所有患者在进行冠状动脉造影前都接受了冠状动脉CTA检查，血管造影期间进行FFR测量和OCT检查.FFR≤0.80的狭窄病变被认为是引起缺血的病变的诊断。分析使用冠状动脉CTA和OCT评估的斑块特征对识别引起缺血的病变的预测价值。
结果：冠状动脉CTA和OCT的狭窄严重程度和斑块特征在引起缺血的病变和未引起缺血的病变之间存在差异。在多变量分析中，冠状动脉CTA低衰减斑块(比值比[OR]=2.78;P=0.038),血栓（OR=5.13；P=0.042），斑块破裂（OR=3.25；P=0.017），OCT显示的血管内膜(OR=2.57;P=0.012)是缺血性病变的独立预测因子。增加这些斑块特征的数量在预测引起缺血的病变方面提供了增量改善。
结论：冠状动脉狭窄的综合解剖学评估可能为预测引起缺血的病变提供额外的支持信息。
方法：基于前瞻性多中心注册，纳入了159例具有339个中度狭窄的冠状动脉病变的患者。所有患者在进行冠状动脉造影前都接受了冠状动脉CTA检查，血管造影期间进行FFR测量和OCT检查.FFR≤0.80的狭窄病变被认为是引起缺血的病变的诊断。分析使用冠状动脉CTA和OCT评估的斑块特征对识别引起缺血的病变的预测价值。
结果：冠状动脉CTA和OCT的狭窄严重程度和斑块特征在引起缺血的病变和未引起缺血的病变之间存在差异。在多变量分析中，冠状动脉CTA低衰减斑块(比值比[OR]=2.78;P=0.038),血栓（OR=5.13；P=0.042），斑块破裂（OR=3.25；P=0.017），OCT显示的血管内膜(OR=2.57;P=0.012)是缺血性病变的独立预测因子。增加这些斑块特征的数量在预测引起缺血的病变方面提供了增量改善。
结论：冠状动脉狭窄的综合解剖学评估可能为预测引起缺血的病变提供额外的支持信息。
