AbstractBackground 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 p p 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.
Ding et al. (Sun,) studied this question.