Coronary angiography-based shear stress computation to identify high-risk coronary artery plaques: Are we there yet?

Peter H. Stone ◽  
Ahmet Umit Coskun
Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Santiago Garcia ◽  
Herbert B Ward ◽  
Thomas Moritz ◽  
Fred Littooy ◽  
Steve Goldman ◽  

Background: The Coronary Artery Revascularization Prophylaxis (CARP) Trial was a multicenter randomized study that showed no long-term survival benefit with revascularization prior to elective vascular surgery in patients with stable coronary artery disease (CAD). To determine whether subsets with high-risk anatomy benefited from preoperative revascularization, survival was determined in randomized and registry patients who underwent coronary angiography within 6 months of vascular surgery. Methods: Over a 4-year enrollment period, 4,876 patients were screened prior to vascular surgery and 1,048 (21.5%) had preoperative coronary angiography for either multiple cardiac risks or an abnormal preoperative stress test. The cohort included 462 randomized and 586 excluded patients and the probability of survival was determined at 2.5 years following vascular surgery. Results: Of 1,048 patients with preoperative coronary angiography, non-obstructive disease (< 70%) was present in 192 (18.3%) and 1 vessel disease (VD) was present in 244 (23.3%), with a combined survival of 0.84. Previous bypass surgery (CABG) was present in 225 (21.5%), with a survival of 0.78. High risk coronary anatomy in patients without prior CABG included 2-VD in 204 (19.5%), 3-VD in 130 (12.4%) and an unprotected left main stenosis > 50% in 48 (4.6%) patients. Their long-term survival according to the preoperative revascularization status is shown in the Table . Conclusions: The results demonstrate that an unprotected left main stenosis was present in 4.6% of high-risk patients presenting for vascular surgery and was the only anatomical subset that demonstrated a survival benefit with preoperative revascularization prior to vascular surgery. These data may warrant additional strategies to identify patients with unprotected left main disease either prior to or immediately following vascular surgery. Long-Term Probability of Survival at 2.5 Years Following Vascular Surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
T Zanchin ◽  
C Bourantas ◽  
R Torii ◽  
P W S Serruys ◽  
A Karagiannis ◽  

Abstract Background Low Endothelial shear stress (ESS) is a well-known instigator of coronary atherosclerosis. Prospective intravascular ultrasound (IVUS)-based imaging studies with computational fluid dynamic analysis revealed its predictive merit in-vivo. However, whether coronary modelling derived from quantitative coronary angiography (QCA) is equally effective in detecting high-risk plaques remains to be established. Purpose To examine the value of endothelial shear stress (ESS) estimated in three-dimensional (3D) QCA models in detecting plaques that are likely to progress and cause events. Method We analysed the baseline intravascular ultrasound virtual histology (IVUS-VH) and angiographic data from 28 non-culprit lesions with a vulnerable phenotype (i.e., fibroatheroma or thin cap fibroatheroma) that caused major adverse cardiac events or required revascularization (nc-MACE-R) at 5-year follow-up and from a control group of 119 vulnerable plaques that remained quiescent. The segments studied by IVUS-VH at baseline were reconstructed using 3D-QCA software and in the obtained geometries blood flow simulation was performed and we estimated the resting Pd/Pa across the vulnerable plaque and the mean ESS values in 3mm sub-segments. A propensity score was built by the baseline plaque characteristics and the hemodynamic indices and its efficacy in detecting nc-MACE-R lesions was examined. Results Nc-MACE-R lesions were longer (32.5mm [18.0, 41.6], vs. 19.6mm [12.7, 31.3], p=0.03), had smaller minimum lumen area (MLA) (3.65mm2 [3.26, 4.36] vs. 5.03mm2 [3.98, 6.66], p<0.01), increased plaque burden (PB) (69.4% [63.5, 72.0] vs. 60.8% [53.7, 66.5], p<0.01), were exposed to higher ESS (9.40Pa [6.3, 12.5] vs. 4.1Pa [3.0, 6.9], p<0.01), and exhibited a lower resting Pd/Pa (0.97 [0.95, 0.98] vs. 0.98 [0.97, 0.99], p<0.01]. In multivariable analysis the only independent predictor of nc-MACE-R was the maximum 3mm ESS value (hazard ratio: 1.08 [1.02, 1.16], P=0.016). Lesions exposed to high ESS (>4.95Pa) with a high-risk anatomy (MLA<4mm2and PB>70%) had a higher nc-MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS that had high (20.0%) or low-risk anatomy (7.1%, P<0.001). Conclusion In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information and in combination with lesion anatomy enabled more accurate identification of nc-MACE-R lesions. Further research in a larger number of patients is need to confirm these findings before the conduction of large scale prospective studies that will combine intravascular imaging and 3D-QCA modelling to more accurately detect vulnerable plaques.

2016 ◽  
Vol 67 (13) ◽  
pp. 372
Yiannis S. Chatzizisis ◽  
Konstantinos Toutouzas ◽  
Andreas Giannopoulos ◽  
Maria Riga ◽  
Antonios Antoniadis ◽  

2010 ◽  
Vol 11 (3) ◽  
pp. 182-185 ◽  
Raphaël Pedro Martins ◽  
Guillaume Leurent ◽  
Hervé Corbineau ◽  
Olivier Fouquet ◽  
Sébastien Seconda ◽  

2021 ◽  
Mateus dos Santos Viana ◽  
Thomaz Emanoel Azevedo Silva ◽  
Gabriela Oliveira Bagano ◽  
Bruna de Sá Barreto Pontes ◽  
Milton Henrique Vitoria de Melo ◽  

ABSTRACTIntroductionCoronary anatomy is one of the strongest risk predictors in Acute Coronary Syndromes (ACS), which justifies early coronary angiography. Diagnostic scores for predicting outcomes are usually superior to clinical judgment. Despite being validated for prognosis, the GRACE score has been used to discriminate patients with high or low probability of anatomical severity.ObjectiveTo test the hypothesis that the GRACE score actually predicts anatomical severity.MethodsThe study was carried out by assessing consecutive patients with ACS who underwent invasive angiography. Severe anatomical disease was defined as obstructive involvement (≥ 70% in diameter) in (1) left main coronary artery or (2) double or triple vessel disease involving proximal left anterior descending artery or (3) subocclusion. The GRACE score was evaluated under numerical and dichotomous tests.ResultsA total of 733 patients were evaluated, aged 63 ± 14 years, 61% male and GRACE score of 119 ± 37. Obstructive coronary disease was observed in 81% of the patients, classified as one, two or three vessel disease, or left main coronary artery involvement in 28%, 23%, 26% and 4%, respectively. The area under the ROC curve of the GRACE score was 0.65 (95% CI = 0.61 - 0.69) for predicting severe disease. The cutoff point below which the first GRACE tertile is defined (109) was used to dichotomize low-risk (N = 318) and medium-high-risk (N = 415) samples. This standard definition of intermediate-high risk by the GRACE score (> 109) revealed sensitivity of 67% in detecting severe anatomy (95% CI = 61% - 72%) and specificity of 50% (95% CI = 46% - 55%), resulting in positive likelihood ratio of 1.3 (95% CI = 1.2 - 1.5) and negative likelihood ratio of 0.66 (95% CI = 0.55 - 0.80). There was a weak correlation between GRACE and anatomical scores such as SYNTAX (r = 0.36, P < 0.001) and Gensini (r = 0.36, P < 0.001).ConclusionDespite statistical association with extent of anatomical coronary disease, the GRACE Score is not accurate to predict severity of disease before coronary angiography.

Radiology ◽  
2009 ◽  
Vol 252 (2) ◽  
pp. 377-385 ◽  
Hervé Gouya ◽  
Olivier Varenne ◽  
Ludovic Trinquart ◽  
Emmanuel Touzé ◽  
Olivier Vignaux ◽  

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