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Predictive performance of the perivascular fat attenuation index for interventional antegrade percutaneous coronary
Yue Xi1,2, Lei Huang3, Junhai Hao4
1Department of Radiology, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
Insights
The perivascular fat attenuation index (FAI) can predict the success of antegrade percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Combining FAI with morphological factors improves prediction accuracy for PCI failure.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Chronic total occlusion (CTO) poses challenges for percutaneous coronary intervention (PCI).
- Predicting PCI success is crucial for optimal patient management.
- Novel imaging biomarkers are needed to assess CTO complexity.
Purpose of the Study:
- To investigate the association between perivascular fat attenuation index (FAI) and antegrade PCI success in CTO.
- To evaluate FAI as a predictor of antegrade PCI failure in CTO.
- To assess the added value of FAI in combination with morphological characteristics for predicting PCI outcomes.
Main Methods:
- Retrospective analysis of 156 patients with CTO undergoing coronary computed tomography angiography (CCTA) and conventional coronary angiography (CAG).
- Measurement of perivascular FAI of CTO lesions.
- Assessment of CCTA-based CTO lesion morphologic characteristics (calcification, length, remodeling).
- Statistical analysis including multivariable analysis and receiver operating characteristic (ROC) curve analysis.
Main Results:
- Successful antegrade PCI (A-PCI) was achieved in 67.3% of CTO lesions.
- Perivascular FAI was significantly lower in the failed A-PCI group compared to the successful group (p < 0.001).
- FAI ≤ -77.50 HU, severe calcification, negative remodeling, and occlusion length ≥ 20.25 mm were independent predictors of A-PCI failure.
- Combining FAI with morphological characteristics significantly improved the prediction performance of A-PCI failure (AUC 0.93 vs. 0.77, p < 0.001).
Conclusions:
- Perivascular FAI is a valuable non-invasive imaging biomarker for predicting antegrade PCI success in CTO.
- FAI complements traditional morphological indicators derived from CCTA for assessing CTO complexity.
- The integration of FAI into risk stratification models may aid in selecting appropriate interventional strategies for CTO.
Objectives:
This study aimed to investigate the association between the perivascular fat attenuation index (FAI) and the success of the antegrade percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).
Methods:
This study evaluated patients with only one CTO lesion observed on conventional coronary angiography (CAG) who underwent coronary computed tomography angiography (CCTA) < 1 month before CAG, from 2018 to 2019. The clinical data, CCTA-based CTO lesion morphologic characteristics, and perivascular FAI of CTO lesions were recorded and analysed.
Results:
In total, 156 patients with CTOs were enrolled in this study. Successful antegrade PCI (A-PCI) was achieved in 105 CTO lesions (67.3%). The perivascular FAI of the failed A-PCI group was significantly lower than the successful A-PCI group (-84.76 ± 10.44 Hounsfield unit (HU) vs. -67.54 ± 9.94 HU; p < 0.001), and the cut-off value determined by the receiver operating characteristic (ROC) curve was -77.50 HU. Multivariable analysis revealed no statistical significance in the clinical data, FAI ≤ -77.50 HU (odds ratio (OR): 33.96), negative remodeling (OR: 4.36), severe calcification degree (OR: 4.43) and occlusion length ≥ 20.25 mm (OR: 3.89) were independent predictors of A-PCI failure. The prediction performance of combining the three morphologic characteristics (severe calcification, occlusion length ≥ 20.25 mm, and negative remodeling) with FAI ≤ -77.50 HU was better than that of the three morphologic characteristics alone (0.93 versus 0.77, p < 0.001).
Conclusions:
As a non-invasive index for detecting coronary inflammation, FAI complements indicators based on coronary CTA well and may be helpful for choosing appropriate interventional strategies.
Key Points:
• Perivascular FAI of CTO was significantly higher in the failed A-PCI group. • The combination of FAI with other morphological predictors showed higher predictive performance of failed A-PCI for CTOs. • FAI is a good complement to indicators based on coronary CTA.
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