TY - JOUR
T1 - Importance of coronary artery lumen size in the relationship between coronary artery plaque and vessel-specific ischemia
T2 - A post hoc analysis of CREDENCE and PACIFIC-1
AU - CREDENCE and PACIFIC-1 Investigators
AU - Ding, Yipu
AU - Kamila, Putri Annisa
AU - Nurmohamed, Nick S.
AU - Danad, Ibrahim
AU - Jukema, Ruurt A.
AU - Raijmakers, Pieter G.
AU - Driessen, Roel S.
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Chang, Hyuk Jae
AU - Choi, Andrew D.
AU - Knaapen, Paul
AU - Liu, Hongbin
AU - Bax, Jeroen J.
AU - van Rosendael, Alexander
AU - Heo, Ran
AU - Park, Hyung Bok
AU - Marques, Hugo
AU - Stuijfzand, Wijnand J.
AU - Bom, Michiel J.
AU - Diemen, Pepijn van
AU - Choi, Jung Hyun
AU - Doh, Joon Hyung
AU - Her, Ae Young
AU - Koo, Bon Kwon
AU - Nam, Chang Wook
AU - Shin, Sang Hoon
AU - Cole, Jason
AU - Gimelli, Alessia
AU - Khan, Muhammad Akram
AU - Lu, Bin
AU - Gao, Yang
AU - Nabi, Faisal
AU - Al-Mallah, Mouaz H.
AU - Nakazato, Ryo
AU - Schoepf, U. Joseph
AU - Thompson, Randall C.
AU - Jang, James J.
AU - Ridner, Michael
AU - Rowan, Chris
AU - Avelar, Erick
AU - Généreux, Philippe
AU - de Waard, Guus A.
N1 - Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2026/5/1
Y1 - 2026/5/1
N2 - BACKGROUND: While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV).METHODS: This post-hoc analysis included coronary arteries from the CREDENCE (n = 1716) and PACIFIC-1 (n = 612) trials, involving patients with suspected stable coronary artery disease (CAD) who underwent coronary computed tomography angiography (CTA) and invasive fractional flow reserve (FFR) measurement. AI-enabled quantitative CTA was used to assess plaque burden and composition. Ischemia was defined as FFR≤0.80. Each major coronary artery was analyzed. ALA was stratified into tertiles.RESULTS: Larger ALA was associated with younger age, higher body mass index, and more nitrate use in both cohorts (all p < 0.05). Increasing ALA correlated with lower diameter stenosis, reduced ischemia prevalence, and smaller plaque burden despite greater total plaque and non-calcified plaque volumes. In both cohorts, ischemia prevalence increased with stenosis severity, yet within each stenosis category, vessels with smaller ALA showed consistently higher ischemia rates. E.g., in CREDENCE vessels with 50 %-70 % stenosis, ischemia was observed in 60.0 % of small, 43.8 % of medium, and 27.8 % of large vessels (all p < 0.05). Similar patterns were observed within PAV strata across all plaque subtypes. Multivariable analysis confirmed ALA independently associated with lower ischemia prevalence in both studies (both p < 0.001).CONCLUSIONS: Coronary artery lumen size significantly attenuates the relationship between atherosclerosis/stenosis and ischemia. These findings support integrating lumen assessment in coronary CTA-based risk stratification.
AB - BACKGROUND: While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV).METHODS: This post-hoc analysis included coronary arteries from the CREDENCE (n = 1716) and PACIFIC-1 (n = 612) trials, involving patients with suspected stable coronary artery disease (CAD) who underwent coronary computed tomography angiography (CTA) and invasive fractional flow reserve (FFR) measurement. AI-enabled quantitative CTA was used to assess plaque burden and composition. Ischemia was defined as FFR≤0.80. Each major coronary artery was analyzed. ALA was stratified into tertiles.RESULTS: Larger ALA was associated with younger age, higher body mass index, and more nitrate use in both cohorts (all p < 0.05). Increasing ALA correlated with lower diameter stenosis, reduced ischemia prevalence, and smaller plaque burden despite greater total plaque and non-calcified plaque volumes. In both cohorts, ischemia prevalence increased with stenosis severity, yet within each stenosis category, vessels with smaller ALA showed consistently higher ischemia rates. E.g., in CREDENCE vessels with 50 %-70 % stenosis, ischemia was observed in 60.0 % of small, 43.8 % of medium, and 27.8 % of large vessels (all p < 0.05). Similar patterns were observed within PAV strata across all plaque subtypes. Multivariable analysis confirmed ALA independently associated with lower ischemia prevalence in both studies (both p < 0.001).CONCLUSIONS: Coronary artery lumen size significantly attenuates the relationship between atherosclerosis/stenosis and ischemia. These findings support integrating lumen assessment in coronary CTA-based risk stratification.
KW - Coronary CT angiography
KW - Coronary artery disease
KW - Ischemia
KW - Lumen size
KW - Plaque burden
KW - Severity of Illness Index
KW - Predictive Value of Tests
KW - Prevalence
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Male
KW - Plaque, Atherosclerotic
KW - Computed Tomography Angiography
KW - Coronary Artery Disease/diagnostic imaging
KW - Coronary Stenosis/diagnostic imaging
KW - Fractional Flow Reserve, Myocardial
KW - Female
KW - Aged
KW - Coronary Vessels/diagnostic imaging
KW - Coronary Angiography/methods
UR - https://www.scopus.com/pages/publications/105031862315
UR - https://www.scopus.com/inward/citedby.url?scp=105031862315&partnerID=8YFLogxK
U2 - 10.1016/j.jcct.2026.02.002
DO - 10.1016/j.jcct.2026.02.002
M3 - Article
C2 - 41748401
AN - SCOPUS:105031862315
SN - 1934-5925
VL - 20
SP - 226
EP - 233
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 3
ER -