Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification

Abstract

ObjectiveTo assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification.Materials and MethodsPatients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded.ResultsA total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA.ConclusionCalcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals

“…In total, 50 KJR (9101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354565758), 492 ER, and 254 Radiology articles reported original research studies analyzing patient data. Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month.…”

“…Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month. The point estimate value of this proportion was slightly larger in KJR than in ER and Radiology, although the difference was not statistically significant.…”

The Chinese Experience of Imaging in Cardiac Intervention

“…Yu and colleagues used a CT-derived calcification remodeling index to predict the initiation of rotational atherectomy in patients with severe coronary calcification lesions. It supported the feasibility of using CT-derived indices before the percutaneous coronary intervention (PCI) procedure and providing incremental predictive value 18. Another study by Qiao et al19 used CT-derived functional SYNTAX score (FSS CTA ) to predict major adverse cardiovascular events (MACE) in patients with the 3-vessel disease.…”

“…It supported the feasibility of using CT-derived indices before the percutaneous coronary intervention (PCI) procedure and providing incremental predictive value. 18 Another study by Qiao et al 19 used CT-derived functional SYNTAX score (FSS CTA ) to predict major adverse cardiovascular events (MACE) in patients with the 3-vessel disease. The result showed that FSS CTA demonstrated a better predictive accuracy for MACE than the CTbased SYNTAX score (SS CTA ) (area under the curve: 0.81 vs. 0.75, P = 0.01).…”

The use of lesion-specific calcium morphology to guide the appropriate use of dynamic CT myocardial perfusion imaging and CT fractional flow reserve

“…All lesions on the major epicardial arteries (diameter ≥2 mm) were evaluated with dedicated plaque analysis software (Coronary Plaque Analysis version 4.3, Siemens Healthineers). The following qualitative and quantitative parameters were measured and recorded: (I) diameter of the stenosis (DS) and lesion length; (II) patient-based and vessel-based CACS; (III) lesion-specific calcium morphology according to the involved quadrants by calcification (13). The detailed definitions of the above parameters are given in the Appendix 1.…”