Author + information
- Carlos Collet1,
- Patrick Serruys2,
- Bernard Chevalier3,
- Angel Cequier4,
- Jean Fajadet5,
- Ad Van Boven6,
- Dougal Mcclean7,
- Jan Piek8,
- Antonio Bartorelli9,
- Stephan Windecker10 and
- Yoshinobu Onuma11
- 1AMC, Amsterdam, Netherlands
- 2Imperial College, London, United Kingdom
- 3Institut Cardiovasculaire Paris Sud, Massy, France
- 4Bellvitge University Hospital, Barcelona, Spain
- 5Clinique Pasteur, Toulouse, France
- 6Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
- 7Christchurch Hospital, Christchurch, New Zealand
- 8Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- 9University of Milan, Milan, Milan, Italy
- 10University Hospital Bern, Bern, Switzerland
- 11Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Coronary computed tomography angiography (CCTA) has emerged as a non-invasive method to evaluate patients with suspected or established coronary artery disease. The diagnostic accuracy of CCTA to evaluate angiographic outcomes after bioresorbable vascular scaffold (BVS) implantation has not been well established.
In the ABSORB II study, patients were randomized either to receive treatment with the BVS or everolimus-eluting metallic stent. At 3-year follow-up, 238 patients (258 lesions) treated with BVS underwent coronary angiography with intravascular ultrasound (IVUS) evaluation, and CCTA. The diagnostic accuracy of CCTA was assessed by the area under the receiver-operating-characteristics curve (AUC) with coronary angiography and IVUS as references.
The mean differences in CCTA-derived minimum luminal diameter (MLD) was -0.14 mm (Limits of agreement -0.88 to 0.60) with quantitative coronary angiography as reference whereas the mean difference in minimal luminal area (MLA) was 0.73 mm2 (Limits of agreement -1.85 to 3.30) with IVUS as reference. The per-scaffold diagnostic accuracy of CCTA for detecting stenosis based on coronary angiography diameter stenosis ≥ 50% revealed an AUC of 0.88 (95%CI 0.82 to 0.92) with a sensitivity of 80% (95%CI 28 to 99) and a specificity of 100% (95%CI 98 to 100) whereas diagnostic accuracy based on IVUS MLA ≤ 2.5 mm2 showed an AUC of 0.83 (95%CI 0.77 to 0.88) with a sensitivity of 71% (95%CI 44 to 90) and a specificity of 82% (95%CI 75 to 87). The diagnostic accuracy of CCTA was similar to coronary angiography in its ability to identify patients with a significant lesion based on the IVUS criteria (p=0.75).
CCTA has good diagnostic accuracy to detect in-scaffold luminal obstruction and to assess luminal dimensions after BVS implantation. CCTA and coronary angiography yielded similar diagnostic accuracy to identify the presence and severity of obstructive disease. CCTA might become the method of choice for the evaluation of patients treated with BVS.
IMAGING: Imaging: Non-Invasive