723 PREDICTORS OF PERCUTANEOUS CORONARY INTERVENTION DERIVED FROM CORONARY CT ANGIOGRAPHY IN PATIENTS WITH CHRONIC CORONARY SYNDROME

Abstract

Abstract Aims To assess whether quantitative and qualitative plaque features derived from coronary CT angiography (CCTA) could predict subsequent coronary revascularization by percutaneous coronary intervention (PCI) in patients with suspected chronic coronary syndrome (CCS). Methods From April 2019 to October 2020, all consecutive patients with suspected CCS undergoing CCTA and computation of Fractional Flow Reserve derived from CCTA (FFRCT), with consequent referral to coronary angiography and invasive physiological assessment, were included. The FFRCT 3D-model was used to calculate i) FFRCT value, in distal coronary segments where invasive FFR was measured, ii) trans-lesion gradient, defined as the difference in FFRCT units across the lesion derived from CTA, iii) vessel gradient, i.e., the difference in FFRCT units along the vessel. Quantitative and qualitative plaque analysis at CCTA was performed by experienced operators as recommended by current guidelines. Results Overall, 108 patients (143 vessels) were included. The mean age was 65±8.6 years, and 11% were diabetics. At baseline, 87 (80%) patients had chest pain. Left ventricular ejection fraction was 59±4.6%. Sixty (55.5%) patients underwent PCI, 8 (7.5%) were treated with coronary artery bypass graft (CABG), and 40 (37%) were referred to medical therapy (MT). At CCTA, the lesions undergoing PCI were significantly longer (38.85±17mm, p<0.001), with more severe diameter stenosis (45.43±16.69, p=0.002), lower minimal lumen area (MLA) (2.30± 1.33mm, p=0.013), higher plaque volume (292.31±158.32mm3, p<0.001), greater fibrous-fatty and necrotic core volume (18.87±20.7 and 14.78±27.42, p<0.001), greater maximum calcium arc in the lesion (108.63±65.9, p<0.001) and lower calcium arc the MLA (88.5±10 p=0.037) than the others referred to CABG/MT. In the PCI group, FFRCT was significantly lower (0.69± 0.11, p<0.001), while trans-lesion and vessel gradients were higher (0.09±0.04 and 0.27±0.10 respectively, p<0.001) than the other groups. On multivariate regression model, corrected for all confounding factors, longer lesions (OR 1.11, CI 1,01-1,21, p=0.022), higher maximum calcium arc (OR 1.02, CI 1.01-1.04, p= 0.007) and lower calcium arc at the MLA (OR 0.99, CI 0.98-0.99, p=0.031) were shown to be independent predictors of referral for PCI. Conclusion Lesion length and calcium arc derived from CCTA predict subsequent revascularization by PCI in patients suspected of CAD.