Coronary CT Angiography-Derived Plaque and Hemodynamic Characteristics for In-Stent Restenosis: A Self-Controlled...

In-stent restenosis (ISR) after percutaneous coronary interventions (PCI) remains a significant challenge.

This study aimed to investigate the predictive ability of coronary CT angiography (CTA) derived plaque and hemodynamic characteristics for ISR.

In this retrospective study, we included stable patients who underwent coronary CTA prior to the index PCI and subsequently exhibited both ISR and non-ISR in different stented lesions during follow-up. The plaque and hemodynamic characteristics derived from coronary CTA were assessed. The incremental discriminant and reclassification abilities for ISR prediction were compared among 2 models (model 1: procedural characteristics; model 2: model 1 + plaque characteristics + hemodynamic characteristics).

A total of 52 patients with 120 lesions were included in the study, comprising 63 ISR lesions and 57 non-ISR lesions. The average age was 62.6 ± 9.9 years old and 67.3% (35/52) were male. The median interval between index PCI and ISR was 22 (14.3-66.8) months. Compared with non-ISR group, lesions in ISR group exhibited more adverse plaque characteristics (APC) and adverse hemodynamic characteristics (AHC). The risk of developing ISR in lesions with ≥ 2 APC and ≥ 3 AHC was significantly higher than that with < 2 APC and < 3 AHC (HR = 11.02, 95% CI = 1.63-16.32, p = 0.002). The C-index of Model 2 (0.858; 95% CI: 0.782-0.925) was higher than that of Model 1 (0.762; 95% CI: 0.670-0.845) (p = 0.017).

The noninvasive assessment of CTA-derived plaque characteristics and hemodynamic features enhanced the prediction of ISR after PCI in stable patients.