title: Coronary computed tomography angiography indicates complexity of percutaneous coronary interventions.
abstract: BACKGROUND
  Coronary computed tomography angiography (CCTA) provides information regarding lesion morphology and three-dimensional coronary anatomy incremental to coronary angiography. We addressed the question whether preprocedural CCTA bears potential for guiding percutaneous coronary interventions (PCI).
  
  
  RESULTS
  Sixty-six coronary lesions attempted with PCI within 6 months of preprocedural CCTA were retrospectively assessed. Lesion parameters from unenhanced computed tomography (CT) for calcium scoring and CCTA were analyzed and compared with PCI complexity. Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high pressure balloons, or rotablator. Complex PCIs were observed in 32 interventions (48%). Median Agatston score and Hounsfield units were higher in lesions with complex as compared to those with non-complex interventions with 130 (interquartile range, 23-276) vs 29 (0-158; P=.01), and 493 (245-631) vs 341 (68-520 Hounsfield Units; P=.04), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-39) vs 5 (0-19.5 mm³; P=.007), and 48 (15-99) vs. 16 (1.5-63 mg hydroxyapatite/mm³; P=.03), respectively. Lesions leading to complex PCI were longer [1.8 (1.2-2.8) vs 1.3 (0.8-1.7) cm; P=.03], and had a higher rate of calcified plaques (23% vs 3%; P=.03). There was a significant correlation between CCTA- and angiography-derived local SYNTAX Scores (P<.001); the CCTA-derived score seems to be predictive for failed and complex PCI (area under curve = 0.75 ± 0.13 and 0.66 ± 0.08, respectively).
  
  
  CONCLUSIONS
  Preprocedural lesion assessment by CCTA indicates complexity of PCI. In patients with suspected complex coronary anatomy, prior CCTA adds important information for planning PCI.
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Switzerland.
authors.forename: B E
authors.initials: BE
authors.lastname: Stähli
authors.forename: F
authors.initials: F
authors.lastname: Bonassin
authors.forename: R
authors.initials: R
authors.lastname: Goetti
authors.forename: S M
authors.initials: SM
authors.lastname: Küest
authors.forename: M
authors.initials: M
authors.lastname: Frank
authors.forename: L A
authors.initials: LA
authors.lastname: Altwegg
authors.forename: C
authors.initials: C
authors.lastname: Gebhard
authors.forename: A
authors.initials: A
authors.lastname: Levis
authors.forename: M B
authors.initials: MB
authors.lastname: Wischnewsky
authors.forename: T F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: H
authors.initials: H
authors.lastname: Alkadhi
authors.forename: P A
authors.initials: PA
authors.lastname: Kaufmann
authors.forename: W
authors.initials: W
authors.lastname: Maier
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*