Abstract
Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated.Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared.Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFRCT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT did not improve the model performance.Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFRCT.
Highlights
Acute coronary syndrome (ACS) is one of the leading causes of death in most countries [1], and predicting ACS risk prior to fatal events has been a major challenge in patients with coronary artery disease
The median interval from CCTA to ACS events was 338.0 (161.5–535.0) days, and ACS events were comprised by 93.1% of myocardial infarction and 6.9% of unstable angina
A total of 216 lesions were identified on CCTA taken prior to ACS, including 66 culprit lesions and 150 nonculprit lesions
Summary
Acute coronary syndrome (ACS) is one of the leading causes of death in most countries [1], and predicting ACS risk prior to fatal events has been a major challenge in patients with coronary artery disease. It has been speculated that identification of local hemodynamic parameters displayed better prediction of plaque rupture risk [12]. Their clinical utilization has still been limited in daily practice since it requires additional resources and is a time-consuming process [13, 14]. Whether the assessment of all diverse local hemodynamic indices provides incremental value has not been fully understood. In this regard, we performed this study to investigate the relationship among various local hemodynamic parameters and their comparability in prediction of ACS risk. Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated
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