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
Cardiac
  • 23 Downloads

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

Keywords

Coronary artery disease Multidetector computed tomography Angiography Stent Percutaneous coronary intervention 

Abbreviations

CCTA

Coronary computed tomography angiography

ICA

Invasive coronary angiography

ISR

In-stent restenosis

LAP

Low attenuation plaque

MLA

Minimal lumen area

MLD

Minimal lumen diameter

NRS

Napkin-ring sign

PCI

Percutaneous coronary intervention

PR

Positive remodelling

Notes

Compliance with ethical standards

Guarantor

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.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

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

References

  1. 1.
    Sousa JE, Serruys PW, Costa MA (2003) New frontiers in cardiology: drug-eluting stents: Part I. Circulation 107:2274–2279CrossRefPubMedGoogle Scholar
  2. 2.
    Sousa JE, Serruys PW, Costa MA (2003) New frontiers in cardiology: drug-eluting stents: Part II. Circulation 107:2283–2289Google Scholar
  3. 3.
    Stettler C, Wandel S, Allemann S et al (2007) Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370:937–948CrossRefPubMedGoogle Scholar
  4. 4.
    Moses JW, Leon MB, Popma JJ et al (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323CrossRefPubMedGoogle Scholar
  5. 5.
    Stone GW, Ellis SG, Cox DA et al (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231CrossRefPubMedGoogle Scholar
  6. 6.
    Farb A, Weber DK, Kolodgie FD et al (2002) Morphological predictors of restenosis after coronary stenting in humans. Circulation 105:2974–2980CrossRefPubMedGoogle Scholar
  7. 7.
    Hoffmann R, Mintz GS, Mehran R et al (1998) Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents. J Am Coll Cardiol 31:43–49CrossRefPubMedGoogle Scholar
  8. 8.
    Sahara M, Kirigaya H, Oikawa Y et al (2003) Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: an intravascular ultrasound study. J Am Coll Cardiol 42:1731–1738CrossRefPubMedGoogle Scholar
  9. 9.
    Motoyama S, Sarai M, Harigaya H et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57CrossRefPubMedGoogle Scholar
  10. 10.
    Otsuka K, Fukuda S, Tanaka A et al (2013) Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging 6:448–457CrossRefPubMedGoogle Scholar
  11. 11.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36CrossRefPubMedGoogle Scholar
  12. 12.
    Hoffmann U, Moselewski F, Nieman K et al (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47:1655–1662CrossRefPubMedGoogle Scholar
  13. 13.
    Hadamitzky M, Freismith B, Meyer T et al (2009) Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. J Am Coll Cardiol Imaging 2:404–411CrossRefGoogle Scholar
  14. 14.
    Min JK, Shaw LJ, Devereux RB et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50:1161–1170CrossRefPubMedGoogle Scholar
  15. 15.
    Cury RC, Abbara S, Achenbach S et al (2016) Coronary Artery Disease - Reporting and Data System (CAD-RADS): an expert consensus document of SCCT, ACR and NASCI: endorsed by the ACC. JACC Cardiovasc Imaging 9:1099–1113CrossRefPubMedGoogle Scholar
  16. 16.
    Puchner SB, Liu T, Mayrhofer T et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 64:684–692CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Motoyama S, Ito H, Sarai M et al (2015) Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 66:337–346CrossRefPubMedGoogle Scholar
  18. 18.
    Bentzon JF, Otsuka F, Virmani R et al (2014) Mechanisms of plaque formation and rupture. Circ Res 114:1852–1866CrossRefPubMedGoogle Scholar
  19. 19.
    Libby P (2013) Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 368:2004–2013CrossRefPubMedGoogle Scholar
  20. 20.
    Ito T, Terashima M, Kaneda H et al (2011) Comparison of in vivo assessment of vulnerable plaque by 64-slice multislice computed tomography versus optical coherence tomography. Am J Cardiol 107:1270–1277CrossRefPubMedGoogle Scholar
  21. 21.
    Nakazawa G, Finn AV, Joner M et al (2008) Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation 118:1138–1145CrossRefPubMedGoogle Scholar
  22. 22.
    Otsuka F, Byrne RA, Yahagi K et al (2015) Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J 36:2147–2159CrossRefPubMedGoogle Scholar
  23. 23.
    Wakabayashi K, Waksman R, Weissman NJ (2012) Edge effect from drug-eluting stents as assessed with serial intravascular ultrasound: a systematic review. Circ Cardiovasc Interv 5:305–311CrossRefPubMedGoogle Scholar
  24. 24.
    Kini AS, Vengrenyuk Y, Shameer K et al (2017) Intracoronary imaging, cholesterol efflux, and transcriptomes after intensive statin treatment: the YELLOW II Study. J Am Coll Cardiol 69:628–640CrossRefPubMedGoogle Scholar

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

Personalised recommendations