Coronary plaque volume quantification using coronary computed tomography angiography is associated with periprocedural myocardial injury in patients with chronic coronary syndrome

Abstract

Background: Percutaneous coronary intervention (PCI) is often complicated by periprocedural myocardial injury (PMI), resulting in poor clinical outcomes. Therefore, it is important to detect plaque that causes myocardial injury before PCI and clarify the cause of the poor outcomes. We aimed to investigate the relationship between PMI and coronary plaque morphology and plaque volume determined using coronary computed tomography angiography (CCTA) in patients with chronic coronary syndrome (CCS).

Methods: Eighty-nine patients with CCS underwent elective PCI and CCTA before PCI. Plaque morphology and volume of the target and total lesions were assessed and stratified into calcified, fibrous, fibrous fatty, and low-attenuation plaque (LAP). High-risk plaque (HRP) on CCTA was defined as positive remodeling, spotty calcification, and the napkin-ring sign.

Results: Thirty-two and fifty-seven patients were classified into the PMI and non-PMI groups, respectively. The total plaque (TP) and LAP volumes of the target lesions were significantly higher in the PMI group than in the non-PMI group. The TP and LAP volumes of the target lesion on CCTA were significant independent predictors of PMI. Net reclassification and integrated discrimination improvement indices significantly improved when TP and LAP volumes were added to the reference model including clinical characteristics and HRP features. Moreover, the TP and LAP volumes of the total lesions per patient were significantly higher in the PMI group than in the non-PMI group.

Conclusion: In patients with CCS, quantitative plaque assessment using CCTA was associated with occurrence of PMI after PCI.

Keywords: Chronic coronary syndrome; Computed tomography; High-risk plaque; Low-attenuation plaque volume; Periprocedural myocardial injury; Total plaque volume.