基于冠状动脉 CT 血管造影的非钙化斑块负荷定量可改善分叉病变主血管支架置入后边支闭塞的预测：来自 CT-PRECISION 注册研究的结果。
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.
机构信息
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
Medical University of Warsaw, Warsaw, Poland.
出版信息
Clin Res Cardiol. 2021 Jan;110(1):114-123. doi: 10.1007/s00392-020-01658-1. Epub 2020 May 8.
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.
目的
评估计算机断层血管造影术（CTA）定量斑块特征对预测冠状动脉分叉病变介入治疗中边支（SB）闭塞的增量价值。
方法
我们对 CT-PRECISION 注册研究的事后分析中纳入了 340 例 377 处分叉病变患者。每个分叉病变分为三个节段：近端主血管（MV）、远端 MV 和 SB。使用半自动软件分析有冠状动脉斑块证据的节段，允许对冠状动脉斑块形态和狭窄进行定量分析。冠状动脉斑块测量包括钙化斑块和非钙化斑块体积，以及相应的负荷（各自的斑块体积×100%/血管体积）、重构指数和狭窄。
结果
377 处分叉病变中有 28 处（7.5%）发生 SB 闭塞。仅在 SB 节段而非近端和远端 MV 节段中存在可视斑块是唯一能够预测 SB 闭塞的定性参数，其曲线下面积（AUC）为 0.792。在计算 SB 节段的定量斑块参数中，添加非钙化斑块负荷（AUC 0.840，p=0.003）和低密斑块负荷（AUC 0.836，p=0.012）显著提高了预测 SB 闭塞的能力。使用受试者工作特征曲线分析，非钙化斑块负荷和低密斑块负荷的最佳截断值分别为＞33.6%（86%敏感性和 78%特异性）和＞0.9%（89%敏感性和 73%特异性）。
结论
CTA 衍生的非钙化斑块负荷，当与可视 SB 斑块相结合时，可显著提高冠状动脉分叉病变介入治疗中 SB 闭塞的预测能力。
试验注册
ClinicalTrials.gov 标识符：NCT03709836，于 2018 年 10 月 17 日注册。
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