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

Kajetan Grodecki,Damini Dey,Piotr J Slomka,Cezary Kepka,Anna M Michalowska,Mariusz Debski,Rafal Wolny,Adam Witkowski,Artur Debski,Adam D Staruch,Maksymilian P Opolski,Jerzy Pregowski,Mariusz Kruk,Ilona Michalowska,Sebastien Cadet

doi:10.1007/s00392-020-01658-1

Abstract

ObjectivesTo assess the incremental value of quantitative plaque features measured from computed tomography angiography (CTA) for predicting side branch (SB) occlusion in coronary bifurcation intervention.MethodsWe 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.ResultsSB 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.ConclusionsCTA-derived noncalcified plaque burden, when added to the visually identified SB plaque, significantly improves the prediction of SB occlusion in coronary bifurcation intervention.Trial registrationClinicalTrials.gov Identifier: NCT03709836 registered on October 17, 2018.

Highlights

Treatment of coronary bifurcation lesions accounts for 15–20% of all percutaneous coronary intervention (PCI) procedures [1]
We investigated quantitative computed tomography (CT) plaque characteristics associated with side branch (SB) occlusion in patients undergoing coronary bifurcation intervention with initial stenting of the main vessel (MV)
0.412 0.278 < 0.001 increased noncalcified—but not calcified—plaque deposits when compared to lesions without SB occlusion, and (2) the addition of quantitative noncalcified plaque features to the visual identification of SB plaque significantly improves the prediction of SB occlusion

Summary

Introduction

Treatment of coronary bifurcation lesions accounts for 15–20% of all percutaneous coronary intervention (PCI) procedures [1]. Studies utilizing intravascular imaging techniques identified plaque and carina shift as two major mechanisms of SB compromise, data on the role of plaque morphology in this complication are scarce [6,7,8]. The number of patients undergoing CTA before invasive coronary angiography is expected to rise, underscoring the importance of utilizing all computed tomography (CT) information for planning and guiding PCI [11]. Whereas the distribution of coronary plaque included in the CTA-derived RESOLVE score was found to be predictive of SB occlusion, there is paucity of data on the relationship between plaque morphology and the risk of SB compromise in coronary bifurcation interventions [4]. This study, aimed to assess the incremental value of quantitative morphological plaque features measured from CTA for predicting SB occlusion in coronary bifurcation intervention

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