Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention

• DOI: 10.1016/j.jcct.2023.05.005
• Publication Date: 2023-05-27T19:22:22Z
• Authors: Saima Mushtaq; Gianluca Pontone; Edoardo Conte; Daniela Trabattoni; Stefano Galli; Sebastiano Gili; Sarah Troiano; Giovanni Teruzzi; Andrea Baggiano; Alice Bonomi; Vincenzo Mallia; Davide Marchetti; Matteo Schillaci; Eleonora Melotti; Marta Belmonte; Andrea Igoren Gua...; Carlo Gigante; Mauro Pepi; Antonio L. Bartor...; Daniele Andreini
• Keywords: Male; Computed Tomography Angiography; percutaneous coronary intervention; Myocardial Perfusion Imaging; Coronary Stenosis; 610; Coronary Artery Disease; Constriction, Pathologic; Middle Aged; Coronary Angiography; Coronary Restenosis; Perfusion; Percutaneous Coronary Intervention; Predictive Value of Tests; Humans; myocardial perfusion; coronary artery disease; Aged

The ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP.We enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP ​+ ​CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of "subendocardial" perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. "transmural" perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness.In 150 patients (132 men, mean age 65.1 ​± ​9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p ​< ​0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p ​< ​0.001) and 94.9% vs. 97.9% (p ​= ​0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p ​< ​0.0001).This study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.