Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification

  • Yu, Mengmeng (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Li, Yuehua (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Li, Wenbin (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Lu, Zhigang (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Wei, Meng (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Zhang, Jiayin (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital)
  • Received : 2017.01.09
  • Accepted : 2017.01.23
  • Published : 2017.10.01
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Abstract

Objective: To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods: Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results: A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ${\leq}0.84$ was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion: Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ${\leq}0.84$ was the strongest independent predictor for using RA prior to stent implantation.

Keywords

Acknowledgement

Supported by : National Natural Science Foundation of China, Shanghai Municipal Education Commission-Gaofeng Clinical Medicin

References

  1. Ritchie JL, Hansen DD, Intlekofer MJ, Hall M, Auth DC. Rotational approaches to atherectomy and thrombectomy. Z Kardiol 1987;76 Suppl 6:59-65
  2. Bangalore S, Vlachos HA, Selzer F, Wilensky RL, Kip KE, Williams DO, et al. Percutaneous coronary intervention of moderate to severe calcified coronary lesions: insights from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv 2011;77:22-28 https://doi.org/10.1002/ccd.22613
  3. Moussa I, Ellis SG, Jones M, Kereiakes DJ, McMartin D, Rutherford B, et al. Impact of coronary culprit lesion calcium in patients undergoing paclitaxel-eluting stent implantation (a TAXUS-IV sub study). Am J Cardiol 2005;96:1242-1247 https://doi.org/10.1016/j.amjcard.2005.06.064
  4. Tuzcu EM, Berkalp B, De Franco AC, Ellis SG, Goormastic M, Whitlow PL, et al. The dilemma of diagnosing coronary calcification: angiography versus intravascular ultrasound. J Am Coll Cardiol 1996;27:832-838 https://doi.org/10.1016/0735-1097(95)00537-4
  5. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011;364:226-235 https://doi.org/10.1056/NEJMoa1002358
  6. Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W, van Rooij FJ, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 2005;112:572-577 https://doi.org/10.1161/CIRCULATIONAHA.104.488916
  7. Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, et al. Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification--a subanalysis of the CORE-64 trial. Radiology 2011;261:100-108 https://doi.org/10.1148/radiol.11110537
  8. Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ, et al. Korean guidelines for the appropriate use of cardiac CT. Korean J Radiol 2015;16:251-285 https://doi.org/10.3348/kjr.2015.16.2.251
  9. Li Y, Zhang J, Lu Z, Pan J. Discrepant findings of computed tomography quantification of minimal lumen area of coronary artery stenosis: correlation with intravascular ultrasound. Eur J Radiol 2012;81:3270-3275 https://doi.org/10.1016/j.ejrad.2012.03.010
  10. Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy. JACC Cardiovasc Interv 2014;7:345-353 https://doi.org/10.1016/j.jcin.2013.12.196
  11. Taylor AJ, Burke AP, Farb A, Yousefi P, Malcom GT, Smialek J, et al. Arterial remodeling in the left coronary system: the role of high-density lipoprotein cholesterol. J Am Coll Cardiol 1999;34:760-767 https://doi.org/10.1016/S0735-1097(99)00275-2
  12. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011;58:e44-e122 https://doi.org/10.1016/j.jacc.2011.08.007
  13. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2006;113:30-37 https://doi.org/10.1161/CIRCULATIONAHA.105.580696
  14. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210-215 https://doi.org/10.1001/jama.291.2.210
  15. Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol 1995;25:855-865 https://doi.org/10.1016/0735-1097(94)00462-Y
  16. Lee RT, Grodzinsky AJ, Frank EH, Kamm RD, Schoen FJ. Structure-dependent dynamic mechanical behavior of fibrous caps from human atherosclerotic plaques. Circulation 1991;83:1764-1770 https://doi.org/10.1161/01.CIR.83.5.1764
  17. Hoffmann R, Mintz GS, Popma JJ, Satler LF, Kent KM, Pichard AD, et al. Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study. Eur Heart J 1998;19:1224-1231 https://doi.org/10.1053/euhj.1998.1028
  18. Khattab AA, Otto A, Hochadel M, Toelg R, Geist V, Richardt G. Drug-eluting stents versus bare metal stents following rotational atherectomy for heavily calcified coronary lesions: late angiographic and clinical follow-up results. J Interv Cardiol 2007;20:100-106 https://doi.org/10.1111/j.1540-8183.2007.00243.x
  19. Kawasaki M, Bouma BE, Bressner J, Houser SL, Nadkarni SK, MacNeill BD, et al. Diagnostic accuracy of optical coherence tomography and integrated backscatter intravascular ultrasound images for tissue characterization of human coronary plaques. J Am Coll Cardiol 2006;48:81-88 https://doi.org/10.1016/j.jacc.2006.02.062

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