Abstract 15160: Coronary Computed Tomography Angiography Predicts Complexity of Percutaneous Coronary Interventions
Introduction: Coronary computed tomography angiography (CCTA), increasingly used for non-invasive cardiac imaging, provides additional information regarding lesion morphology, calcification, and 3-dimensional anatomy.Hypothesis: Pre-procedural lesion characterization by CCTA might be useful for planning percutaneous coronary interventions (PCI) and predict the complexity of PCI.
Methods: Pre-procedural CCTA was performed in 79 consecutive patients; 33 patients underwent PCI for 66 single de novo lesions within 6 months. Lesion morphology from CCTA (mixed, soft, and calcified plaque) and parameters from unenhanced CT [local plaque density (Hounsfield Units), Agatston Score (segmental, per lesion), local plaque volume (mm3), local plaque mass (mg hydroxyapatite/mm3), and local plaque length (mm)] were retrospectively assessed and compared with complexity of PCI by blinded investigators. Complex PCI was defined as use of buddy wire, kissing balloon, high pressure balloon, or rotablator, and the occurrence of successfully managed procedural complications (dissection, perforation, and plaque shift). CCTA parameters of lesions with complex and non-complex PCI were compared.
Results: Complex PCI were observed in 35 (53%) of 66 interventions due to the high proportion of severely diseased patients selected for prior CCTA. Median Agatston Score and Hounsfield Units were higher or tended to be higher in lesions with complex as compared to those with non-complex interventions with 120 (interquartile range: 22-275) vs. 27 (0-170; P=0.01); and 466 (290-623) vs. 338 (46-521 Hounsfield Units; P=0.06), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-34) vs. 5 (0-19 mm3; P=0.007); and 46 (14-95) vs. 16 (0-65 mg hydroxyapatite/mm3; P=0.03), respectively. Lesions leading to complex PCI were longer compared to those with non-complex PCI [1.8 (1.2-2.8) vs. 1.3 (0.8-1.7) mm; P=0.02] and had a higher rate of calcified plaques (12.7% vs. 3.0%; P=0.03).
Conclusions: In conclusion, pre-procedural lesion assessment by CCTA predicts complexity of PCI. Thus, in patients with suspected complex coronary anatomy, prior CCTA adds important information to coronary angiography for planning subsequent PCI.
- © 2011 by American Heart Association, Inc.