title: Coronary CT angiography-derived quantitative markers for predicting in-stent restenosis.
abstract: OBJECTIVE
  To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) performed prior to percutaneous coronary intervention (PCI) with stent placement for predicting in-stent restenosis (ISR) as defined by quantitative coronary angiography (QCA).
  
  
  METHODS
  We retrospectively analyzed the data of 74 patients (60 ± 12 years, 72% male) who had undergone dual-source coronary CTA within 3 months prior to a PCI procedure that included stent placement. Quantitative markers of the target vessel were derived from coronary CTA: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (PB in %), remodeling index (RI), and lesion length (LL). Marker performance for predicting ISR, as defined by QCA at follow-up, was assessed.
  
  
  RESULTS
  Twenty-one of 74 stented lesions showed ISR on follow-up (mean 616 ± 447 days). When comparing stent length and LL in patients with ISR, a trend towards less complete stent coverage of the target lesion was observed in cases with ISR (17/21 vs. 4/53 cases, p = 0.07). In multivariate analysis (corrected for dyslipidemia), the following markers showed predictive value for ISR (odds ratio [OR]): NCPV (OR 1.08, p = 0.045), LL (OR 1.38, p = 0.0024), and RI (OR 1.13, p = 0.0019). Sensitivity and specificity for ISR were: NCPV 65% and 80%, LL 74% and 74%, and RI 71% and 78%. At receiver-operating characteristics analysis, NCPV (0.72, p = 0.001), LL (0.77, p < 0.0001), and RI (0.79, p < 0.0001) showed discriminatory power for predicting ISR. A combination of these markers showed incremental predictive value (AUC 0.89, p < 0.0001) with sensitivity and specificity of 90% and 84%, respectively.
  
  
  CONCLUSIONS
  Coronary CTA-derived NCPV, LL, and RI portend predictive value for ISR with incremental predictive value when combining these parameters.
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Tesche
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Taylor M
authors.initials: TM
authors.lastname: Duguay
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stubenrauch
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Russell D
authors.initials: RD
authors.lastname: Rosenberg
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Akos
authors.initials: A
authors.lastname: Varga-Szemes
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Baquet
authors.affiliation: Department of Cardiology, Hospital of the Ludwig-Maximilians-University, Munich, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Jochheim
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Salvatore A
authors.initials: SA
authors.lastname: Chiaramida
authors.affiliation: Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Coronary artery disease; Coronary computed tomography angiography; In-stent restenosis; Quantitative coronary angiography