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Published on: February 16, 2016
Quantification of myocardial mass using coronary computed tomography angiography in bifurcation PCI and association
Dimitrios Strepkos1, Michaella Alexandrou1, Pedro E P Carvalho1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Insights
Quantifying myocardial mass from CT angiography helps predict side branch occlusion after bifurcation PCI. Lower side branch to main vessel myocardial mass ratios indicate a higher risk of side branch occlusion.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- Bifurcation percutaneous coronary intervention (PCI) is complex, with side branch (SB) complications impacting outcomes.
- Predictive markers for SB complications after bifurcation PCI are crucial for improving patient management.
Purpose of the Study:
- To assess if quantifying myocardial mass supplied by an SB can predict outcomes of bifurcation PCI.
- To investigate the relationship between SB myocardial mass supply and SB occlusion (SBO).
Main Methods:
- Coronary computed tomography angiography (CCTA) was used to calculate myocardial mass at risk for 73 patients undergoing bifurcation PCI.
- Flow-based calculations determined the myocardial mass supplied by the main vessel (MV) and SB.
- Statistical analysis correlated the SB to MV myocardial mass supply ratio (SB/MV) with technical success, major adverse cardiovascular events (MACE), and SBO.
Main Results:
- The SB/MV ratio was not associated with technical success or MACE.
- A lower SB/MV ratio was significantly associated with an increased risk of SBO (P = .020).
- Lesions with SBO had higher V-RESOLVE scores and lower SB/MV ratios compared to those without SBO.
Conclusions:
- Myocardial mass quantification using CT analysis is a valuable tool for assessing SBO risk post-bifurcation PCI.
- This imaging-derived metric can aid in risk stratification and procedural planning for bifurcation interventions.
Objectives:
To determine if quantification of the myocardial mass supplied by a side branch (SB) could be predictive of bifurcation percutaneous coronary intervention (PCI) outcomes.
Methods:
The authors examined the characteristics and outcomes of 73 patients (81 lesions) who underwent bifurcation PCI and had coronary computed tomography angiography (CCTA) angiography based computed flow-based calculation of myocardial mass at risk within 6 months prior.
Results:
The lesions analyzed were complex with high V-RESOLVE scores (12.0, 95%, interquartile range [IQR]: 9.0, 13.5). Provisional stenting was used in 67.9%, 2-stent techniques in 32.1%, and conversion from provisional to 2-stent stenting was performed in 11.1% of the lesions. The main vessel (MV) supplied 30.0% (IQR: 24.0%, 36.0%) and the SB supplied 10.0% (IQR: 7.0%, 13.0%) of the myocardium. Technical success was 94.9%. Major adverse cardiovascular events (MACE) occurred in 5.5% of the patients and SB occlusion (SBO) in 12.3% of the lesions. The ratio of SB to MV myocardial mass supply (SB/MV) was not associated with technical success (odds ratio [OR], 11.00; 95% confidence interval [CI], 0.01, 18.79; P = .500) or MACE (OR, 0.02; 95% CI, 0.00, 18.20; P = .300), but was associated with SBO (OR, 6.02*10-6; 95% CI, 2.42*10-10, 0.15; P = .020). SB/MV was normally distributed (W = 0.99, P = .467) with a mean of 0.35 (95% CI, 0.31, 0.38). In lesions where SBO occurred, V-RESOLVE scores were higher (16.0 vs 12.0, P = .017) and the SB/MV ratio was lower (0.22 vs 0.35, P = .007).
Conclusions:
Myocardial mass derived from CT analysis can help assess the risk of SBO after bifurcation PCI.
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