-
Original Article
-
Korean J Intern Med. 2026;41(5):873-883. Published online September 1, 2026.
DOI: https://doi.org/10.3904/kjim.2026.005
- Prognostic implications of functional significance, high-risk plaque and vessel characteristics in patients with diabetes mellitus
-
Jin-Eun Song1, Seokhun Yang1, Masahiro Hoshino2, Taishi Yonetsu3, Jinlong Zhang4, Eun-Seok Shin5, Joon-Hyung Doh6, Chang-Wook Nam7, Jianan Wang4, Shaoliang Chen8, Nobuhiro Tanaka9, Hitoshi Matsuo10, Takashi Kubo9, Hyuk-Jae Chang11, Tsunekazu Kakuta2, Bon-Kwon Koo1
-
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
2Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
3Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
4Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
5Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
6Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
7Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
8Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
9Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
10Department of Cardiology, Gifu Heart Center, Gifu, Japan
11Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author: Bon-Kwon Koo ,Tel: +82-2-2072-2062, Fax: +82-2-3675-0805, Email: bkkoo@snu.ac.kr
- Received: January 3, 2026; Revised: January 31, 2026 Accepted: March 9, 2026.
- Abstract
- Background/Aims
We investigated the prognostic value of high-risk plaque (HRP) and high-risk vessel (HRV) characteristics on coronary computed tomography angiography (CCTA) alongside fractional flow reserve (FFR) in patients with diabetes mellitus (DM).
Methods
We analyzed 307 vessels from 184 diabetic patients who underwent both CCTA and invasive FFR. HRP was defined as the presence of ≥ 3 high-risk features (minimal lumen area < 4 mm2, plaque burden ≥ 70%, low-attenuation plaque, positive remodeling, spotty calcification, or napkin-ring sign). HRV was defined as the presence of ≥ 1 quantitative volumetric parameter above the optimal cutoff. The primary endpoint was target vessel failure (TVF). HRs were adjusted for FFR, HRP, HRV, and the number of clinical risk factors.
Results
Functional significance (FFR ≤ 0.80; adjusted HR 2.56; 95% CI 1.07–6.12; p = 0.034), HRP (adjusted HR 2.29; 95% CI 1.10–4.77; p = 0.028), and HRV (adjusted HR 2.37; 95% CI 1.12–5.01; p = 0.025) were independent predictors of TVF. Notably, deferred vessels with FFR > 0.80 harboring HRP and/or HRV had a significantly higher risk of TVF compared to the deferred low-risk group (HR 4.78; 95% CI 1.68–13.57; p = 0.003), and their prognosis was comparable to that of deferred vessels with functional significance (FFR ≤ 0.80; HR 5.57; 95% CI 1.70–18.24; p = 0.005).
Conclusions
In patients with DM, both lesion-level (HRP) and vessel-level (HRV) characteristics provided incremental prognostic value beyond FFR. Integrating these anatomical risk features may refine risk stratification for diabetic patients, particularly for those with functionally insignificant lesions.
Keywords :Coronary artery disease; Diabetes mellitus; Fractional flow reserve, myocardial; Computed tomography angiography; Plaque, atherosclerotic
