Peri-Coronary Adipose Tissue Is a Predictor of Stent Failure in Patients Undergoing Percutaneous Coronary Intervention

Jason Nogic; Jiwon Kim; Jamie Layland; Kevin Cheng; Damini Dey; Dennis T Wong; James D Cameron; Adam J Brown

doi:10.1016/j.carrev.2023.02.022

Peri-Coronary Adipose Tissue Is a Predictor of Stent Failure in Patients Undergoing Percutaneous Coronary Intervention

Cardiovasc Revasc Med. 2023 Aug:53:61-66. doi: 10.1016/j.carrev.2023.02.022. Epub 2023 Feb 28.

Authors

Jason Nogic¹, Jiwon Kim², Jamie Layland³, Kevin Cheng², Damini Dey⁴, Dennis T Wong², James D Cameron², Adam J Brown²

Affiliations

¹ Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia. Electronic address: [email protected].
² Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia.
³ Cardiology, Department of Medicine, Peninsula Health, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁴ Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America.

PMID: 36863976
DOI: 10.1016/j.carrev.2023.02.022

Abstract

Purpose: Coronary inflammation is postulated as a driver of atherosclerosis and dysfunctional arterial healing which may trigger stent failure. Pericoronary adipose tissue (PCAT) attenuation, detected on computer tomography coronary angiography (CTCA), is an emerging non-invasive marker of coronary inflammation. This propensity matched study assessed the utility of both lesion specific (PCAT_Lesion) and standardized PCAT attenuation as assessed in the proximal RCA (PCAT_RCA) as a predictor of stent failure in patients undergoing elective percutaneous coronary intervention. This is the first study to our knowledge that assesses the association of PCAT with stent failure.

Methods: Patients undergoing CTCA assessment for coronary artery disease with subsequent stent insertion within 60 days and repeat coronary angiography for any clinical reason within 5 years were included in the study. Stent failure was defined as binary restenosis of >50 % on quantitative coronary angiography analysis or stent thrombosis. Both PCAT_Lesion and PCAT_RCA was assessed utilizing semi-automated proprietary software on baseline CTCA. Patients with stent failure were propensity matched utilizing age, sex, cardiovascular risk factors and procedural characteristics.

Results: One hundred and fifty-one patients met inclusion criteria. Of these, 26 (17.2 %) had study-defined failure. A significant difference in PCAT_Lesion attenuation between patients with and without failure was observed (-79.0 ± 12.6 vs. -85.9 ± 10.3HU, p = 0.035). There was no significant difference in PCAT_RCA attenuation between the two groups (-79.5 ± 10.1 vs -81.0 ± 12.3HU, p = 0.50). Univariate regression analysis showed PCAT_Lesion attenuation was independently associated with stent failure (OR 1.06, 95 % CI 1.01-1.12, P = 0.035).

Conclusions: Patients with stent failure exhibit significantly increased PCAT_Lesion attenuation at baseline. These data suggest that baseline plaque inflammation may be an important driver for coronary stent failure.

MeSH terms

Adipose Tissue / diagnostic imaging
Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / pathology
Coronary Artery Disease* / therapy
Coronary Vessels / diagnostic imaging
Coronary Vessels / pathology
Coronary Vessels / surgery
Humans
Inflammation
Percutaneous Coronary Intervention* / adverse effects
Plaque, Atherosclerotic* / pathology
Stents