P861A quantitative CCTA evaluation in non-obstructive coronary artery disease for the diagnosis of vessel-specific ischemia: results from the prospective, multicenter, international CREDENCE trial

Abstract Aim To improve the diagnosis of coronary vessel-specific ischemia in non-obstructive coronary artery disease (CAD) using a quantitative whole-heart coronary computed tomography angiography (CCTA) evaluation. To date, predictors of ischemia in non-obstructive CAD remain underexplored. Methods Within the CREDENCE trial, 612 patients with suspected CAD at 13 sites (64±10 years, 70% men) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography with 3-vessel fractional flow reserve (FFR) measurements. For this specific analysis, only vessels with non-obstructive plaque (1–49% maximal diameter stenosis) by CCTA were included. The primary endpoint was coronary vessel-specific ischemia which was defined as FFR ≤0.80 (or ≥90% stenosis). Multivariable logistic regression modeling was performed to evaluate the effect of quantitative CCTA features beyond coronary stenosis on the prevalence of vessel-specific ischemia. Results FFR ≤0.80 (or ≥90% stenosis) was prevalent in 22.8% of 1,102 vessels with non-obstructive plaque. Using a step-wise approach, in addition to diameter stenosis (χ2=72), non-calcified PAV (χ2=126, P<0.001), lumen volume (χ2=175, P<0.001) and number of lesions with >30% stenosis (χ2=187, P=0.001) were independent CCTA-predictors of coronary vessel-specific ischemia (Figure 1). In the final model, diameter stenosis was no longer significantly associated with ischemia (P=0.236). Figure 1 Conclusion In vessels with non-obstructive plaque on CCTA, ischemia was present in approximately 20%. Measures of overall non-calcified plaque burden and smaller lumen volume were more important determinants of vessel-specific ischemia than maximal diameter stenosis. Acknowledgement/Funding NIH R01-HLL118019; Dalio Foundation and Michael J. Wolk Foundation