Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses

Shinichiro Masuda; Pruthvi C. Revaiah; Shigetaka Kageyama; Tsung Ying Tsai; Kotaro Miyashita; Akihiro Tobe; John D. Puskas; Ulf Teichgräber; Ulrich Schneider; Torsten Doenst; Kaoru Tanaka; Johan De Mey; Mark La Meir; Saima Mushtaq; Antonio L. Bartorelli; Giulio Pompilio; Scot Garg; Daniele Andreini; Yoshinobu Onuma; Patrick W. Serruys

doi:10.1016/j.jcct.2024.04.013

Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses

Shinichiro Masuda, Pruthvi C. Revaiah, Shigetaka Kageyama, Tsung Ying Tsai, Kotaro Miyashita, Akihiro Tobe, John D. Puskas, Ulf Teichgräber, Ulrich Schneider, Torsten Doenst, Kaoru Tanaka, Johan De Mey, Mark La Meir, Saima Mushtaq, Antonio L. Bartorelli, Giulio Pompilio, Scot Garg, Daniele Andreini, Yoshinobu Onuma, Patrick W. Serruys

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Abstract

Backgrounds: The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. Objective: This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). Methods: This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opaciﬁcation within the coronary occlusion, with corresponding ICA. Results: Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66–0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. Conclusion: In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT registration number: NCT04142021.

Original language	English
Pages (from-to)	450-456
Number of pages	7
Journal	Journal of Cardiovascular Computed Tomography
Volume	18
Issue number	5
DOIs	https://doi.org/10.1016/j.jcct.2024.04.013
State	Published - 1 Sep 2024
Externally published	Yes

Keywords

Coronary computed tomography angiography
Discordance
Quantitative assessment
Severe stenosis
Total occlusion

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10.1016/j.jcct.2024.04.013

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Masuda, S., Revaiah, P. C., Kageyama, S., Tsai, T. Y., Miyashita, K., Tobe, A., Puskas, J. D., Teichgräber, U., Schneider, U., Doenst, T., Tanaka, K., De Mey, J., La Meir, M., Mushtaq, S., Bartorelli, A. L., Pompilio, G., Garg, S., Andreini, D., Onuma, Y., & Serruys, P. W. (2024). Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses. Journal of Cardiovascular Computed Tomography, 18(5), 450-456. https://doi.org/10.1016/j.jcct.2024.04.013

@article{a920c0c81fe74340930afa2ac2694e59,

title = "Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses",

abstract = "Backgrounds: The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. Objective: This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). Methods: This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opaciﬁcation within the coronary occlusion, with corresponding ICA. Results: Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66–0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. Conclusion: In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT registration number: NCT04142021.",

keywords = "Coronary computed tomography angiography, Discordance, Quantitative assessment, Severe stenosis, Total occlusion",

author = "Shinichiro Masuda and Revaiah, {Pruthvi C.} and Shigetaka Kageyama and Tsai, {Tsung Ying} and Kotaro Miyashita and Akihiro Tobe and Puskas, {John D.} and Ulf Teichgr{\"a}ber and Ulrich Schneider and Torsten Doenst and Kaoru Tanaka and {De Mey}, Johan and {La Meir}, Mark and Saima Mushtaq and Bartorelli, {Antonio L.} and Giulio Pompilio and Scot Garg and Daniele Andreini and Yoshinobu Onuma and Serruys, {Patrick W.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = sep,

day = "1",

doi = "10.1016/j.jcct.2024.04.013",

language = "English",

volume = "18",

pages = "450--456",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

number = "5",

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Masuda, S, Revaiah, PC, Kageyama, S, Tsai, TY, Miyashita, K, Tobe, A, Puskas, JD, Teichgräber, U, Schneider, U, Doenst, T, Tanaka, K, De Mey, J, La Meir, M, Mushtaq, S, Bartorelli, AL, Pompilio, G, Garg, S, Andreini, D, Onuma, Y & Serruys, PW 2024, 'Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses', Journal of Cardiovascular Computed Tomography, vol. 18, no. 5, pp. 450-456. https://doi.org/10.1016/j.jcct.2024.04.013

TY - JOUR

T1 - Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses

AU - Masuda, Shinichiro

AU - Revaiah, Pruthvi C.

AU - Kageyama, Shigetaka

AU - Tsai, Tsung Ying

AU - Miyashita, Kotaro

AU - Tobe, Akihiro

AU - Puskas, John D.

AU - Teichgräber, Ulf

AU - Schneider, Ulrich

AU - Doenst, Torsten

AU - Tanaka, Kaoru

AU - De Mey, Johan

AU - La Meir, Mark

AU - Mushtaq, Saima

AU - Bartorelli, Antonio L.

AU - Pompilio, Giulio

AU - Garg, Scot

AU - Andreini, Daniele

AU - Onuma, Yoshinobu

AU - Serruys, Patrick W.

PY - 2024/9/1

Y1 - 2024/9/1

N2 - Backgrounds: The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. Objective: This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). Methods: This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opaciﬁcation within the coronary occlusion, with corresponding ICA. Results: Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66–0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. Conclusion: In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT registration number: NCT04142021.

AB - Backgrounds: The impact of quantitative assessment to differentiate total occlusions (TOs) from severe stenoses on coronary computed tomography angiography (CCTA) remains unknown. Objective: This study investigated whether quantitative characteristics assessed on CCTA could help differentiate a TO from a severe stenosis on invasive coronary angiography (ICA). Methods: This study is a sub-analysis of the FASTTRACK CABG (NCT04142021) in which both CCTA and ICA were routinely performed. Quantitative analysis was performed with semi-automated CCTA plaque-analysis software. Blinded analysts compared TOs on CCTA, defined as a complete lack of contrast opaciﬁcation within the coronary occlusion, with corresponding ICA. Results: Eighty-four TOs were seen on CCTA in 59 of the 114 patients enrolled in the trial. The concordance in diagnosing a TO between ICA and CCTA was 56.0% (n = 47). Compared to severe stenoses, TOs had a significantly longer lesion length (25.1 ± 23.0 mm vs 9.4 ± 11.2 mm, P < 0.001). The best cut-off value to differentiate a TO from severe stenosis was a lesion length of 5.5 mm (area under the curve 0.77, 95% CI: 0.66–0.87), with a 91.1% sensitivity and 61.1% specificity. Dense calcium percentage atheroma volume (PAV) was significantly higher in TOs compared to severe stenoses (18.7 ± 19.6% vs. 6.6 ± 13.0%, P < 0.001), whilst the opposite was seen for fibro-fatty PAV (31.3 ± 14.2% vs. 19.5 ± 10.5%, P < 0.001). On a multivariable logistic regression analysis, lesion length (>5.5 mm) was the only parameter associated with differentiating a TO from a severe stenosis. Conclusion: In quantitative CCTA analysis, a lesion length >5.5 mm was the only independent predictor differentiating a TO from a severe stenosis. NCT registration number: NCT04142021.

KW - Coronary computed tomography angiography

KW - Discordance

KW - Quantitative assessment

KW - Severe stenosis

KW - Total occlusion

UR - http://www.scopus.com/inward/record.url?scp=85192185384&partnerID=8YFLogxK

U2 - 10.1016/j.jcct.2024.04.013

DO - 10.1016/j.jcct.2024.04.013

M3 - Article

AN - SCOPUS:85192185384

SN - 1934-5925

VL - 18

SP - 450

EP - 456

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

IS - 5

ER -

Quantitative coronary computed tomography assessment for differentiating between total occlusions and severe stenoses

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Keywords

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