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Published on: September 22, 2023
Lesion-specific coronary artery calcium score to predict stent underexpansion
Wentao Yang1, Ke Xu1, Xi Fu1
1Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Background:
Previous intracoronary imaging studies have shown that coronary artery calcium (CAC) is an independent risk factor of stent underexpansion; however, limited preintervention assessments of CAC have been performed using noninvasive methods. We aimed to determine the association between lesion-specific CAC score and stent underexpansion.
Methods:
In this retrospective observational study, we included 416 lesions from 359 patients who underwent intravascular ultrasound (IVUS)-guided stent implantation. CAC of each lesion was quantified using the Agatston method derived from either nongated noncontrast chest CT (NCCT) or electrocardiogram-gated coronary CT angiography (CCTA). The primary endpoint was stent underexpansion defined as minimum stent area of <80% of the average reference lumen area.
Results:
Overall, stent underexpansion occurred in 144 (34.6%) of 416 lesions. Lesion-specific CAC score was significantly negatively correlated with the stent expansion rate (in NCCT cohort, r = 0.8113, P < 0.05; in CCTA cohort, r = 0.8024, P < 0.05). The optimal cutoff values of lesion-specific CAC score to predict stent underexpansion were >200 in both NCCT (sensitivity, 91.4%; specificity, 66.8%) and CCTA (sensitivity, 84.6%; specificity, 64.3%) cohort, which were associated with 24.94-fold increased risk of stent underexpansion in NCCT cohort and 13.56-fold increased risk of stent underexpansion in CCTA cohort.
Conclusions:
In this study, we found that lesion-specific CAC scores in both NCCT and CCTA cohorts were significantly independently associated with an increased risk of stent underexpansion, and the cutoff value to predict stent underexpansion was >200.
