Performance of functional and morphological evaluations of intermediate coronary lesions during long-term follow-up

Abstract Introduction Coronary CT angiography (CCTA) has become one of the main imaging modalities for stable coronary artery disease (CAD) [1]. The evaluation of atherosclerotic plaque can now be improved through detailed coronary artery plaque (CAP) analysis using dedicated CCTA software. Quantitative flow ratio (QFR) is a novel, angiography (ICA) based technique that allows for the evaluation of the functional significance of coronary artery stenosis [2]. Purpose The aim of this study was to compare detailed CAP features with QFR based functional analysis of the same lesion, with a long-term perspective on lesion revascularization (PCI). Methods A total of 45 patients with no previous history of CAD were enrolled in this study. All patients underwent CCTA and were diagnosed with intermediate stenosis (IS) (defined as 50-69%), followed by ICA and QFR analysis. For CAP analysis in IS, a semi-automated, dedicated CCTA program (QAngio CT) was used. For the same IS lesion post-ICA QFR analysis was performed (QAngio XA-3D QFR analysis solution version 2.0). 7-year follow-up (FU) was conducted to evaluate the prognostic value of significant CAP features for IS PCI. QFR analysis was performed after the decision to proceed with IS PCI had been made (median time to PCI: 2178.0±747.40). Results We studied 45 lesions and categorized them as non-significant (QFR-negative, QFR≥0.80; n=29) and functionally significant (QFR-positive, QFR