PreDiction and Validation of Clinical CoursE of Coronary Artery DiSease With CT-Derived Non-Invasive HemodYnamic Phenotyping and Plaque Characterization (DESTINY Study)

The study population was collected from Samsung Medical Center. Target population is patients who suffered a clearly documented ACS (acute myocardial infarction [MI] or unstable angina with objective evidence of plaque rupture) or those who underwent significant lesion progression in angiography and treated by percutaneous coronary intervention (PCI) and had undergone CCTA from 6 months to 3 years prior to the coronary events.

CCTA images were screened for plaque characteristics and CFD analysis at core laboratories in Elucid Bioimaging, Inc, MA, USA and Shanghai Institute of Cardiovascular Diseases, Shanghai, China, respectively. Lesions with diameter stenosis (DS) > 30% based on CCTA evaluation were included analysis. The presence of conventional CCTA-HRPC (minimum lumen area<<4 mm2, plaque burden≥70%, low-attenuation plaque, positive remodeling, napkin-ring sign, and spotty calcification) and parameters from tissue characterization using VascuCAP software will be assessed in each lesion by an independent observer blinded to the clinical data and CFD results. The hemodynamic parameters from CFD will include 1) per-vessel FFR derived from CCTA (FFRCT); 2) change in FFRCT across the lesion (△FFRCT); 3) FFRCT pullback pressure gradient (PPG) index (FFRCT-PPG index); 4) Fractional myocardial mass (FMM) of the target stenosis.

Using the occurrence of ACS or PCI for the progressed lesion as clinical endpoint, prognostic implications of CCTA-derived HRPC or hemodynamic parameters will be analyzed.

Inclusion criteria

• Patients who presented with ACS and underwent invasive coronary angiography with identifiable culprit lesion
• Patients who presented with stable ischemic heart disease and underwent invasive coronary angiography for the significant epicardial coronary stenosis
• The patients who underwent coronary CT angiography, regardless of the reason (for example, routine healthcare check-up, or evaluation for stable angina or atypical chest pain) prior to the acute event.
• Time limit of CCTA: 6 months ~ 3 years prior to the event.
• Definition of ACS:

• The patients with acute myocardial infarction should meet one of the following criteria;

• Cardiac enzyme elevation "and"
• Identified culprit lesion confirmed by invasive coronary angiography, IVUS, or OCT
• The patients with unstable angina should be accompanied by the evidence of plaque rupture confirmed with invasive coronary angiography, IVUS, or OCT

Exclusion criteria

Exclusion criteria

for Patient enrollment

• Patients with acute coronary syndrome without clear evidence of culprit lesion
• Patients with stents in two or more vessel territories prior to CCTA
• Poor quality of CCTA which is unsuitable for plaque and CFD analysis
• Patients with ACS culprit lesion in a stented vessel
• Patients with previous history of coronary artery bypass graft surgery
• Secondary myocardial infarction due to other general medical conditions, such as sepsis, arrhythmia, bleeding, etc.
• Poor quality CCTA images unsuitable for CFD analysis
• No available unprocessed CCTA data