In patients with diabetes mellitus, functional significance (FFR ≤ 0.80), high-risk plaque (HRP), and high-risk vessel (HRV) characteristics were independent predictors of target vessel failure, and deferred vessels with FFR > 0.80 but harboring HRP and/or HRV had a significantly higher risk comparable to that of functionally significant lesions.
Functional significance (FFR ≤ 0.80) was an independent predictor of target vessel failure in diabetic patients.
High-risk plaque (HRP) on CCTA was an independent predictor of target vessel failure in diabetic patients.
High-risk vessel (HRV) characteristics on CCTA were an independent predictor of target vessel failure in diabetic patients.
Deferred vessels with FFR > 0.80 that harbored HRP and/or HRV had a significantly higher risk of TVF compared to the deferred low-risk group.
The prognosis of deferred FFR > 0.80 vessels with HRP and/or HRV was comparable to that of functionally significant (FFR ≤ 0.80) deferred vessels.
Both lesion-level (HRP) and vessel-level (HRV) CCTA characteristics provided incremental prognostic value beyond FFR in diabetic patients.
This research suggests that in people with diabetes who have coronary artery disease, looking at the physical characteristics of plaques (fatty deposits in arteries) and overall vessel appearance on CT scans provides important information about future heart events — information that goes beyond what a standard pressure-based test (called fractional flow reserve, or FFR) can tell us alone. The study followed 184 diabetic patients and 307 blood vessels, tracking whether those vessels eventually experienced a serious problem (called target vessel failure). Three factors each independently predicted bad outcomes: having a pressure drop across a blockage (FFR ≤ 0.80), having a 'high-risk plaque' with multiple dangerous features on CT, and having a 'high-risk vessel' with abnormal volume measurements on CT. A particularly notable finding was about vessels where the pressure test looked reassuring (FFR > 0.80, meaning doctors would typically decide not to treat them). When those vessels also had high-risk plaque or high-risk vessel features on CT, their risk of future problems was nearly five times higher than similar untreated vessels without those features — and almost as high as the risk seen in vessels where the pressure test itself indicated significant blockage. This suggests that CT scan features can identify a dangerous subset of lesions that a pressure test alone would miss. This research suggests that combining CT-based anatomical risk assessment with functional pressure measurements may improve how doctors identify which diabetic patients are at highest risk for future cardiac events, especially those whose arteries look 'safe' by pressure testing alone. Diabetes is known to promote widespread, diffuse coronary disease, and these findings highlight that the structural characteristics of plaques and vessels carry prognostic meaning beyond blood flow measurements in this patient population.
Song J, Yang S, Hoshino M, Yonetsu T, Zhang J, Shin E, et al.. (2026). Prognostic implications of functional significance, high-risk plaque and vessel characteristics in patients with diabetes mellitus.. The Korean journal of internal medicine. https://doi.org/10.3904/kjim.2026.005