Prognostic Implications of Angiographically Derived Coronary Radial Wall Strain in Diabetic Patients and Non-Flow-Limiting Stenosis
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Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Zhiqing Wang1, Elvin Kedhi2, Xun Liu3
1Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Background:
Coronary radial wall strain (RWS) represents a novel approach enabling discrimination of vulnerable plaques with prognostic significance.
Objectives:
This study sought to evaluate the prognostic impact of RWS in diabetic patients with non-flow-limiting coronary stenosis when compared with optical coherence tomography-detected vulnerability features (OCT-VFs).
Methods:
This was a post hoc analysis of the COMBINE OCT-FFR dataset. The primary endpoint was lesion-oriented composite endpoint (LOCE), a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization.
Results:
RWS was assessed in 435 eligible non-flow-limiting lesions from 366 patients. Lesion-level maximal RWS was predictive of lesions with any OCT-VFs (area under the curve: 0.630 [95% CI: 0.571-0.688]; P < 0.001). The median follow-up was 3.2 years (Q1-Q3: 2.2-4.1 years). With a prespecified cutoff of ≥13.0%, the incidence of LOCE was 17.0% (15/88; 95% CI: 9.0%-25.1%) in RWS-positive vs 6.8% (19/278; 95% CI: 3.8%-9.8%) in RWS-negative patients (HR: 2.70; 95% CI: 1.37-5.32; P = 0.004). Positive RWS predicted LOCE independently from any OCT-VFs (direct effect β = 0.099 [95% CI: 0.029-0.168]; P = 0.006; indirect effect β = 0.004 [95% CI: -0.008 to 0.015]; P = 0.555; mediation proportion 3.9% [95% CI: -5.0% to 20.3%]). Adding RWS to any OCT-VFs mainly improved the reclassification for LOCE in the lower-risk strata (positive continuous net reclassification improvement [cNRI] -0.060 [95% CI: -0.420 to 0.318]; P = 0.749; negative cNRI 0.583 [95% CI: 0.474-0.681]; P < 0.001; integrated discrimination improvement 0.066 [95% CI: 0.013-0.182]; P = 0.010).
Conclusions:
In diabetic patients with non-flow-limiting stenosis, RWS can help to localize stenoses with OCT-VFs. RWS predicts increased risk for LOCE, both independently from-and incrementally beyond-OCT-VFs. (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients [COMBINE OCT-FFR]; NCT02989740).
