NCT04794868: DESTINY

PreDiction and Validation of Clinical CoursE of Coronary Artery DiSease With CT-Derived Non-Invasive HemodYnamic Phenotyping and Plaque Characterization (DESTINY Study)

Completed Last updated 14 March 2025

What this trial tests

trial testing CCTA-derived high risk plaque characteristics in Acute Coronary Syndrome in 356 participants. Completed in 31 December 2024.

Timeline

1 April 2020

Primary endpoint
31 December 2024

31 December 2024

Quick facts

Lead sponsor	Samsung Medical Center
Status	Completed
Study type	OBSERVATIONAL
Enrollment	356
Start date	1 April 2020
Primary completion	31 December 2024
Estimated completion	31 December 2024
Sites	2 locations across China, South Korea

Drugs / interventions tested

• CCTA-derived high risk plaque characteristics
• CFD-derived hemodynamic parameters

Conditions studied

• Acute Coronary Syndrome — all drugs for Acute Coronary Syndrome →
• Ischemic Heart Disease — all drugs for Ischemic Heart Disease →

Sponsor

Samsung Medical Center

Who can join

Eligibility, any sex, with Acute Coronary Syndrome or Ischemic Heart Disease. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Acute coronary syndrome (ACS) and sudden cardiac death can be the first manifestation of coronary artery disease and are the leading cause of death in the majority of the world's population. The main pathophysiology of ACS is well-known and fibrous cap thickness, presence of a lipid core, and the degree of inflammation have been proposed as the key determinants of plaque vulnerability. Previous studies using virtual histology intravascular ultrasound or optical coherence tomography showed that clinical application of this concept improved risk prediction of ACS. However, these approaches have not been widely adopted in daily practice due to relatively low positive predictive values, low prevalence of high-risk plaques and the invasive nature of diagnostic modalities.

Non-invasive imaging studies with coronary computed tomography angiography (CCTA) also showed the clinical value of CCTA-derived high risk plaque characteristics (HRPC). In addition, the recent progress in CCTA and computational fluid dynamics (CFD) technologies enables simultaneous assessment of anatomical lesion severity, presence of HRPC and quantification of hemodynamic forces acting on plaques in patient-specific geometric models. As plaque rupture is a complicated biomechanical process influenced by the structure and constituents of the plaque as well as the external mechanical and hemodynamic forces acting on the plaque, a comprehensive evaluation of lesion geometry, plaque characteristics and hemodynamic parameters may enhance the identification of high-risk plaque and the prediction of ACS risk.

In this regard, the current study is designed to evaluate prognostic implications of comprehensive non-invasive hemodynamic assessment using CCTA and CFD in the identification of high risk plaques that caused subsequent ACS.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

1. Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events.
   Lee SH, Hong D, Dai N, Shin D, et al · · 2022 · cited 13× · PMID 35677691 · DOI 10.3389/fcvm.2022.871450
2. Fractional Flow Reserve and Fractional Flow Reserve Gradient From CCTA for Predicting Future Coronary Events.
   Hong D, Dai N, Lee SH, Shin D, et al · · 2024 · cited 1× · PMID 39553907 · DOI 10.1016/j.jacasi.2024.06.007
3. Biomechanical index for predicting the risk of acute coronary syndrome.
   Johnson MJ, Abdelmalik MRA, Choi G, Hossain SS, et al · · 2026 · PMID 41953669 · DOI 10.3389/fcvm.2026.1766059