European Radiology

, Volume 28, Issue 8, pp 3441–3453 | Cite as

Coronary plaque characteristics on baseline CT predict the need for late revascularization in symptomatic patients after percutaneous intervention

  • Mengmeng Yu
  • Zhigang Lu
  • Wenbin Li
  • Meng Wei
  • Jing Yan
  • Jiayin Zhang



To assess pre-procedural plaque characteristics as determined by coronary CT angiography (CCTA) and their associations with late revascularization in symptomatic post-procedural patients.


Symptomatic patients with pre-procedural CCTA were prospectively enrolled and referred for invasive coronary angiography (ICA). Plaque characterization was performed on the basis of baseline CCTA data. Multivariate logistic regression analysis with a stepwise selection method was performed to identify independent predictors of late revascularization.


Seventy-eight patients with 134 lesions were included. Late revascularization was performed to treat 15 ISRs and 22 de novo lesions. Lesions with late revascularization showed higher prevalence rates of low-attenuation plaque (LAP) and positive remodelling (PR) (70.3% vs. 23.7% and 86.5% vs. 30.9%; both p < 0.001) at baseline CCTA. However, the incidence of spotty calcification or napkin-ring sign (NRS) was not significantly different between the subgroups. According to ROC curve analysis, PR and LAP showed the largest AUC values for diagnosing lesions with late revascularization (AUC = 0.78 and 0.73, both p < 0.001). In multivariate analysis, LAP and PR (odds ratio = 6.30 and 13.94; both p < 0.05) were revealed to be independent predictors for late revascularization.


LAP and PR observed by baseline CCTA independently predict late revascularization caused by ISR or progression of de novo lesions.

Key points

• LAP and PR observed by baseline CT are predictors of late revascularization.

• NRS and spotty calcification are not associated with late revascularization.

• CT plaque characterization is useful in identifying lesions at high risk of late revascularization.


Coronary artery disease Multidetector computed tomography Angiography Stent Percutaneous coronary intervention 



Coronary computed tomography angiography


Invasive coronary angiography


In-stent restenosis


Low attenuation plaque


Minimal lumen area


Minimal lumen diameter


Napkin-ring sign


Percutaneous coronary intervention


Positive remodelling



This study has received funding by National Natural Science Foundation of China (Grant No.: 81671678), Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No.: 20161428) and Shanghai Key Discipline of Medical Imaging (No.: 2017ZZ02005).

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Jiayin Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

None of study subjects or cohorts have been previously reported.


• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5320_MOESM1_ESM.docx (92 kb)
ESM 1 (DOCX 92 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Institute of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  2. 2.Department of CardiologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  3. 3.Siemens Healthcare LtdShanghaiChina

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