CCTA characterization of coronary atherosclerosis diffuseness and focality using FFR-CT and plaque burden: results from the PRECISE trial

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Introduction Coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) is typically assessed using a dichotomous ≥ 50 % stenosis threshold. However, CAD diffuseness may also influence patient management and outcomes. The PRECISE trial provides high quality data to examine these relationships. Methods and results In this PRECISE substudy, patients with stable suspected CAD undergoing CCTA with FFR-CT and quantitative plaque analysis were evaluated. The FFR-CT drop across a stenosis was defined as stenosisFFR-CT, and the drop attributed to diffuse disease as diffuseFFR-CT. Patients with ≥ 50 % stenosis were classified using cohort medians of stenosisFFR-CT and diffuseFFR-CT into four phenotypes: focal (FOC), diffuse (DIF), combined focal and diffuse (DIFFOC), or no hemodynamically significant CAD (NoHEM). Participants without ≥ 50 % stenosis constituted a fifth group. A total of 737 participants were included (mean age 60 ± 10 years, 44 % female): NoHEM (n = 37), DIF (n = 53), FOC (n = 57), DIFFOC (n = 37), and < 50 % stenosis (n = 553). Total plaque volume (TPV) was highest in DIFFOC (262 [175–504] mm 3 ), followed by DIF (210 [97–302] mm 3 ), FOC (209 [88–415] mm 3 ), NoHEM (153 [87–254] mm 3 ), and < 50 % stenosis (7 [0–59] mm 3 ; p < 0.0001). FOC patients more frequently reported typical angina (p = 0.04) while symptom intensity was similar across the phenotypes. Revascularization was performed in 51 % (FOC), 49 % (DIFFOC), 6 % (DIF), 5 % (NoHEM), and 2 % (<50 % stenosis). Conclusion Focal and mixed CAD phenotypes were clinically similar, aside from more typical angina in focal disease. Revascularization was performed in approximately half of patients with focal patterns, regardless of a diffuse component.

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