{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:15:46Z","timestamp":1789460146154,"version":"build-2803163510"},"reference-count":35,"publisher":"Korean Association of Internal Medicine","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HI19C0481"],"award-info":[{"award-number":["HI19C0481"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HC19C0305"],"award-info":[{"award-number":["HC19C0305"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003569","name":"Ministry of Food and Drug Safety","doi-asserted-by":"publisher","award":["RS-2023-00215667"],"award-info":[{"award-number":["RS-2023-00215667"]}],"id":[{"id":"10.13039\/501100003569","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["kjim.org"],"crossmark-restriction":true},"short-container-title":["Korean J Intern Med"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:p>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 \u2265 3 high-risk features (minimal lumen area &lt; 4 mm2, plaque burden \u2265 70%, low-attenuation plaque, positive remodeling, spotty calcification, or napkin-ring sign). HRV was defined as the presence of \u2265 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 \u2264 0.80; adjusted HR 2.56; 95% CI 1.07\u20136.12; p = 0.034), HRP (adjusted HR 2.29; 95% CI 1.10\u20134.77; p = 0.028), and HRV (adjusted HR 2.37; 95% CI 1.12\u20135.01; p = 0.025) were independent predictors of TVF. Notably, deferred vessels with FFR &gt; 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\u201313.57; p = 0.003), and their prognosis was comparable to that of deferred vessels with functional significance (FFR \u2264 0.80; HR 5.57; 95% CI 1.70\u201318.24; 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.<\/jats:p>","DOI":"10.3904\/kjim.2026.005","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T02:15:56Z","timestamp":1788747356000},"page":"873-883","update-policy":"https:\/\/doi.org\/10.3904\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic implications of functional significance, high-risk plaque and vessel characteristics in patients with diabetes mellitus"],"prefix":"10.3904","volume":"41","author":[{"given":"Jin-Eun","family":"Song","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seokhun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Hoshino","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taishi","family":"Yonetsu","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun-Seok","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Hyung","family":"Doh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Wook","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoliang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gifu Heart Center, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Kubo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuk-Jae","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsunekazu","family":"Kakuta","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8188-3348","authenticated-orcid":true,"given":"Bon-Kwon","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2270","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38678.389583.7c","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(10)60484-9","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1800256","type":"journal-article"},{"key":"ref4","first-page":"1461","type":"journal-article","volume-title":"Natural history of diabetic coronary atherosclerosis by quantitative measurement of serial coronary computed tomographic angiography: results of the PARADIGM study","author":"Kim","year":"2018"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2024.12.083","type":"journal-article"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab433","type":"journal-article"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.118.009245","type":"journal-article"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(97)00327-6","type":"journal-article"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(03)00166-9","type":"journal-article"},{"key":"ref10","first-page":"857","type":"journal-article","volume-title":"Comparison of major adverse cardiac events between instantaneous wave-free ratio and fractional flow reserve-guided strategy in patients with or without type 2 diabetes: a secondary analysis of a randomized clinical trial","author":"Lee","year":"2019"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.06.044","type":"journal-article"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.17613","type":"journal-article"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2021.04.004","type":"journal-article"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.02.060","type":"journal-article"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.117.029289","type":"journal-article"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1979.03290450033020","type":"journal-article"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199807233390404","type":"journal-article"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.94.8.1818","type":"journal-article"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051352","type":"journal-article"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.09.068","type":"journal-article"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra061889","type":"journal-article"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv690","type":"journal-article"},{"key":"ref23","first-page":"1","type":"journal-article","volume-title":"Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve","author":"Park","year":"2015"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-022-02611-1","type":"journal-article"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.4070\/kcj.2023.0117","type":"journal-article"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-023-01751-5","type":"journal-article"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-016-0417-2","type":"journal-article"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2019.12.019","type":"journal-article"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.05.032","type":"journal-article"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.05.040","type":"journal-article"},{"key":"ref31","first-page":"1150","type":"journal-article","volume-title":"Comparison of nonculprit coronary plaque characteristics between patients with and without diabetes: a 3-vessel optical coherence tomography study","author":"Kato","year":"2012"},{"key":"ref32","first-page":"503","type":"journal-article","volume-title":"The relationship between volumetric plaque components and classical cardiovascular risk factors and the metabolic syndrome a 3-vessel coronary artery virtual histology-intravascular ultrasound analysis","author":"Zheng","year":"2011"},{"key":"ref33","first-page":"991","type":"journal-article","volume-title":"Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease","author":"De Bruyne","year":"2012"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(24)00413-6","type":"journal-article"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf273","type":"journal-article"}],"container-title":["The Korean Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/kjim.org\/upload\/kjim-2026-005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/kjim.org\/journal\/view.php?doi=10.3904\/kjim.2026.005","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/kjim.org\/upload\/kjim-2026-005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:59:23Z","timestamp":1789459163000},"score":1,"resource":{"primary":{"URL":"http:\/\/kjim.org\/journal\/view.php?doi=10.3904\/kjim.2026.005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"URL":"https:\/\/doi.org\/10.3904\/kjim.2026.005","relation":{},"ISSN":["1226-3303","2005-6648"],"issn-type":[{"value":"1226-3303","type":"print"},{"value":"2005-6648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"assertion":[{"value":"2026-01-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}