Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Int J Cardiol. 2024 Dec 15;417:132543. doi: 10.1016/j.ijcard.2024.132543. Epub 2024 Sep 13.
Prognostic markers for long-term outcomes are lacking in patients with deferred (nonculprit) coronary artery lesions. This study aimed to identify the morphological criteria for predicting adverse outcomes and validate their clinical impact. Using deep learning models, we extracted geometrical parameters and maximal attenuation (or calcium) burden index (ABI-max or CBI-max) from the intravascular ultrasound (IVUS) images of nonculprit vessels in 1115 patients. The endpoints included cardiac death, myocardial infarction, and target vessel revascularization of nonculprit vessel. Cardiac death occurred in 27 (2.4 %) patients at 3 years and 39 (3.5 %) patients at 5 years. At 5 years, the cardiac death-free survival rate was significantly lower with ABP-max ≥11.37 % vs. < 11.37 % (90.0 % vs. 98.7 %), CBI-max ≥13.40 % vs. < 13.40 % (92.8 % vs. 98.4 %), and percent atheroma volume ≥ 51.35 % vs. < 51.35 % (94.0 % vs. 97.7) (all log-rank p < 0.001). The independent predictors of 5-year cardiovascular mortality were age (hazard ratio [HR] 1.21), female sex (HR 0.33), history of heart failure (HR 6.06), chronic kidney disease (HR 18.28), ABI-max (HR 1.04), and CBI-max (HR 1.05). The independent determinants of 5-year target vessel revascularization of nonculprit vessel were fractional flow reserve (HR 0.95 per 0.01 increase), minimal lumen area (HR 0.63), and plaque burden (HR 1.15). In patients with nonculprit coronary artery lesions, a large burden of attenuated or calcified plaques predicted cardiac mortality, while IVUS geometry was associated with repeat revascularization. Thus, deep learning-based IVUS analysis of the whole target vessel may help clinicians identify high-risk lesions.
对于延迟（非罪犯）冠状动脉病变的患者，缺乏长期预后的预测标志物。本研究旨在确定预测不良结局的形态学标准，并验证其临床影响。我们使用深度学习模型，从 1115 例患者的非罪犯血管的血管内超声（IVUS）图像中提取几何参数和最大衰减（或钙）负荷指数（ABI-max 或 CBI-max）。终点包括非罪犯血管的心脏死亡、心肌梗死和靶血管血运重建。3 年时，27 例（2.4%）患者发生心脏死亡，5 年时 39 例（3.5%）患者发生心脏死亡。5 年时，ABI-max ≥11.37%与 <11.37%相比，心脏死亡无事件生存率显著降低（90.0% vs. 98.7%），CBI-max ≥13.40%与 <13.40%相比（92.8% vs. 98.4%），斑块负荷体积百分比≥51.35%与 <51.35%相比（94.0% vs. 97.7%）（所有对数秩检验 P<0.001）。5 年心血管死亡率的独立预测因素为年龄（危险比[HR] 1.21）、女性（HR 0.33）、心力衰竭史（HR 6.06）、慢性肾脏病（HR 18.28）、ABI-max（HR 1.04）和 CBI-max（HR 1.05）。非罪犯血管 5 年靶血管血运重建的独立决定因素为血流储备分数（每增加 0.01，HR 0.95）、最小管腔面积（HR 0.63）和斑块负荷（HR 1.15）。在非罪犯冠状动脉病变患者中，大量衰减或钙化斑块负荷预测心脏死亡率，而 IVUS 形态学与再次血运重建相关。因此，基于深度学习的整个靶血管 IVUS 分析可能有助于临床医生识别高危病变。
