Author + information
Percutaneous coronary intervention (PCI) nowadays has become standard of care in symptomatic coronary artery disease (CAD. Lesion localization, severe calcifications, and vessel tortuosity may challenge the skills of the operator and increase the risk of procedural complications. Coronary computed tomography angiography (CCTA) has become a promising non-invasive imaging technique, preprocedural lesion characterization by CCTA might contribute to predict PCI complexity in extensive and complex CAD.
To determine the predictive value of coronary plaque characterization as detected by 64- slice multi-detector Computed tomography(MDCT) in prediction of the procedural complexity of elective percutaneous coronary non CTO intervention.
Retrospective study involving 45 patients in whom PCIs were performed for 60 single coronary lesions within 6 months of pre-procedural CCTA at ICC hospital.
All patients had MDCT coronary angiography The CT derived parameters included in our study was: calcium scoring, plaque anatomy (site, side branch involvement, degree of stenosis, morphological type), plaque length, volume, density and area.
Median Agatston score was significantly higher in lesions with complex as compared to those with non-complex interventions with a mean of 266.51 ±155.93vs 168.76 ± 70.53 with the P value = 0.034. Regarding plaque density, Hounsfield Units were higher in lesions with complex as compared to non-complex PCI (371.85 (48.0 to 1159.0) vs 232.29 (52.0 to 1307.0) Hounsfield Units; P=.033). Median local plaque volume was higher in lesions with complex PCI compared to those with non-complex interventions with a mean of 475.07 (92.0 to 1229.0) mm3 Vs 270.24 (69.0 to 824.0) mm3. The plaque area was found statistically significantly higher in complex PCI procedures over the non complex ones with the mean plaque area in the complex procedures was19.40 ± 14.61 mm2 and in the non complex ones, it was 11.24 ± 7.94 mm2 with the P value = 0.011. Complex PCI had a higher rate of calcified plaques (27.9% vs. 5.9%; P=.046).
pre-procedural CCTA parameters indicate complexity of PCI. Thus, we suggest that in patients with suspected complex coronary anatomy, prior CCTA adds important complementary information to coronary angiography for planning subsequent PCI strategy.