Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry

Abstract

Objectives To assess the incremental value of quantitative plaque features measured from computed tomography angiography (CTA) for predicting side branch (SB) occlusion in coronary bifurcation intervention. Methods We included 340 patients with 377 bifurcation lesions in the post hoc analysis of the CT-PRECISION registry. Each bifurcation was divided into three segments: the proximal main vessel (MV), the distal MV, and the SB. Segments with evidence of coronary plaque were analyzed using semi-automated software allowing for quantitative analysis of coronary plaque morphology and stenosis. Coronary plaque measurements included calcified and noncalcified plaque volumes, and corresponding burdens (respective plaque volumes × 100%/vessel volume), remodeling index, and stenosis. Results SB occlusion occurred in 28 of 377 bifurcation lesions (7.5%). The presence of visually identified plaque in the SB segment, but not in the proximal and distal MV segments, was the only qualitative parameter that predicted SB occlusion with an area under the curve (AUC) of 0.792. Among quantitative plaque parameters calculated for the SB segment, the addition of noncalcified plaque burden (AUC 0.840, p = 0.003) and low-density plaque burden (AUC 0.836, p = 0.012) yielded significant improvements in predicting SB occlusion. Using receiver operating characteristic curve analysis, optimal cut-offs for noncalcified plaque burden and low-density plaque burden were > 33.6% (86% sensitivity and 78% specificity) and > 0.9% (89% sensitivity and 73% specificity), respectively. Conclusions CTA-derived noncalcified plaque burden, when added to the visually identified SB plaque, significantly improves the prediction of SB occlusion in coronary bifurcation intervention. Trial registration ClinicalTrials.gov Identifier: NCT03709836 registered on October 17, 2018.

Visually Estimated RESOLVE Score Based on Coronary Computed Tomography to Predict Side Branch Occlusion in Percutaneous Bifurcation Intervention

“…In this context, the visual CTA-derived V-RESOLVE score is yet another predictor (after quantitative CTA-derived RESOLVE score, Medina class with any involvement of the proximal MV and SB plaque, and the presence of any plaque within the first 5 mm of SB segment on coronary CTA) of SB occlusion in coronary bifurcation intervention. 20,21 Discriminative Performance of CTA-derived V-RESOLVE Score Our data confirmed the ability of CTA-derived V-RESOLVE score to stratify lesions into high-risk group and non-high-risk group of SB occlusion. Specifically, by using the cutoff value of 17 points (defined as the lowest score in quartile 4) for discrimination between high-risk group ( ≥ 17) and non-highrisk group (< 17), the incidence of SB occlusion was significantly higher in the high-risk group (18.6%) than in the non-high-risk group (3.8%).…”

“…In this regard, our findings compare equally with earlier studies on the ability of the angiography-based V-RESOLVE score to predict SB occlusion during coronary bifurcation intervention (with AUC ranging from 0.75 to 0.80), and further extend the utility of coronary CTA for guiding PCI. In this context, the visual CTA-derived V-RESOLVE score is yet another predictor (after quantitative CTA-derived RESOLVE score, Medina class with any involvement of the proximal MV and SB plaque, and the presence of any plaque within the first 5 mm of SB segment on coronary CTA) of SB occlusion in coronary bifurcation intervention 20,21…”

Prediction of side branch occlusion in bifurcational lesions during percutaneous coronary interventions by preprocedural coronary computed tomography using the CT bifurcation score

“…[ 16 ], Grodecki et al . [ 17 ], and Opolski et al [ 18 ], as all of these studies found a significant relation between Medina score and SB occlusion in the studied cases.…”

Predictors and Biomarkers of Subclinical Leaflet Thrombosis after Transcatheter Aortic Valve Implantation

“…However, additional quantification of noncalcified tissue might extend our knowledge of the role of valve composition in LT, as it is hypothesized that the damaged native valve tissue may induce thrombosis due to exposure of TF [ 9 , 65 ]. Until now, the association between noncalcified coronary plaque subsets with adverse cardiac events, as well as unfavorable procedural outcomes of percutaneous coronary interventions, have been well evidenced [ 66 , 67 ]. The anatomy of the aortic valve complex also does not seem to effect the LT risk, with only one study demonstrating an association between the larger diameter of Valsalva sinuses and HALT [ 15 ].…”