The presence of a CN was associated with severe calcification and larger hinge movement of the coronary artery (especially ostial and mid right coronary artery). One-third of the underlying plaque morphology of severely calcified culprit lesions in patients with ACS was caused by a CN.

Angiographic detection of target lesion coronary calcium (compared to intravascular imaging) has not changed in the past 2 decades, and angiographically invisible calcium (only detectable by IVUS or OCT) did not appear to inhibit stent expansion.

Background Recent studies have reported the association between pericoronary inflammation assessed by pericoronary adipose tissue attenuation (PCATA) on computed tomography angiography and worse outcomes in patients with coronary artery disease. We investigated the determinants predicting increased PCATA in patients with known or suspected coronary artery disease. Methods and Results A total of 540 patients who underwent computed tomography angiography and invasive coronary angiography were studied. Mean computed tomography attenuation values of PCAT (−190 to −30 Hounsfield units) (PCATA) were assessed at the proximal 40‐mm segments of all 3 major coronary arteries by crude analysis. Univariable and multivariable analyses were performed to determine the predictors of increased PCATA surrounding the proximal right coronary artery. Mean right coronary artery‐PCATA was −72.22±8.47 Hounsfield units and the average of 3‐vessel PCATA was −70.24±6.60 Hounsfield units. Multivariable linear regression analysis revealed that the independent determinants of right coronary artery‐PCATA were male (β coefficient=4.965, P <0.001), left ventricular mass index (β coefficient=0.040, P =0.025), and angiographically significant stenosis (diameter stenosis >50%) (β coefficient=2.418, P =0.008). Sex‐related determinants were NT‐proBNP level (N‐terminal pro‐B‐type natriuretic peptide; β coefficient <0.001, P =0.026), Agatston score (β coefficient=−0.002, P =0.010), left ventricular mass index (β coefficient=0.041, P =0.028), and significant stenosis (β coefficient=4.006, P <0.001) in male patients and left ventricular ejection fraction (β coefficient=−0.217, P =0.010) and significant stenosis (β coefficient=3.835, P =0.023) in female patients. Conclusions Right coronary artery‐PCATA was associated with multiple clinical characteristics, established risk factors, and the presence of significant stenosis. Our results suggest that clinically significant factors such as sex, left ventricular hypertrophy, ejection fraction, calcification, and epicardial stenosis should be taken into account in the assessment of pericoronary inflammation using computed tomography angiography.

BackgroundDespite a moderate correlation between angiographical stenosis and physiological significance, the mechanism of discordance has not been fully elucidated, particularly regarding the significance of microvascular function. This study sought to clarify whether microvascular function affects visual‐functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR).Methods and ResultsWe assessed QCA, FFR, coronary flow reserve, and the index of microcirculatory resistance in 849 non‐left‐main coronary lesions with visually estimated intermediate stenoses from 532 patients. Clinical and lesion‐specific characteristics and physiological parameters associated with mismatch and reverse mismatch were studied. Coronary flow reserve and index of microcirculatory resistance showed a weak, but significant, correlation with FFR (R=0.306, P<0.001 and R=0.158, P<0.001, respectively). Four hundred twenty‐two lesions were visually nonsignificant (diameter stenosis assessed by QCA [QCA‐DS] ≤50%) and 427 lesions were visually significant (QCA‐DS >50%). Among visually nonsignificant lesions, FFR ≤0.80 (reverse mismatch) was observed in 129 lesions (30.6%). Among visually significant lesions, FFR >0.80 (mismatch) were observed in 179 lesions (41.9%). The significant predictors of reverse mismatch were male sex, nonculprit lesions of acute coronary syndrome, left anterior descending artery location, smaller QCA reference diameter, greater QCA‐DS, lower coronary flow reserve, and lower index of microcirculatory resistance. Mismatch was associated with right coronary artery location, greater QCA reference diameter, smaller QCA‐DS, lesion length, higher coronary flow reserve, and higher index of microcirculatory resistance.ConclusionsThere was a high prevalence of visual‐functional mismatches between QCA and FFR. The discrepancy was related to clinical characteristics, lesion‐specific factors, and microvascular resistance that was undistinguishable by coronary angiography, thus suggesting the importance of physiological lesion assessment.

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