Impact of Subtended Myocardial Mass Assessed by Coronary Computed Tomographic Angiography-Based Myocardial Segmentation

• Published in: The American journal of cardiology 2019-03, Vol.123 (5), p.757-763
• Main Authors: Kang, Soo-Jin, Kim, Young-Hak, Lee, June-Goo, Kang, Do-Yoon, Lee, Pil Hyung, Ahn, Jung-Min, Park, Duk-Woo, Lee, Seung-Whan, Lee, Cheol Whan, Park, Seong-Wook, Park, Seung-Jung, Koo, Hyun Jung, Yun, Sung-Cheol, Jung, Joonho, Kim, Namkug, Kweon, Jihoon, Kang, Joon-Won, Lim, Tae-Hwan, Yang, Dong Hyun
• Format: Article
• Language: English
• Subjects: Algorithms; Angiography; Automation; Clinical decision making; Computation; Computed tomography; Computed Tomography Angiography - methods; Confidence intervals; Coronary Angiography - methods; Coronary artery; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary vessels; Coronary Vessels - diagnostic imaging; Data processing; Decision making; Diagnostic systems; Drug delivery; Female; Follow-Up Studies; Fractional Flow Reserve, Myocardial - physiology; Heart; Heart attacks; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Implantation; Implants; Ischemia; Lesions; Male; Medical imaging; Middle Aged; Myocardial infarction; Myocardium; Parameter identification; Patients; Predictions; Prognosis; Reproducibility of Results; Retrospective Studies; Segmentation; Severity of Illness Index; Software; Stenosis; Stents; Surgical implants; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2018.11.042

Although decision-making for revascularization is based on the extent of ischemic myocardium, the prognostic implication of supplying myocardial territories has not yet been studied. To evaluate the clinical impact of the coronary artery-based myocardial segmentation (CAMS)-derived myocardial volume subtended to the poststenotic segment, and to determine clinically relevant coronary lesions, coronary computed tomography angiography, invasive coronary angiography, and preprocedure fractional flow reserve (FFR) data were analyzed in 664 deferred lesions (in 577 patients) and 401 treated lesions (in 369 patients) with drug-eluting stent implantation, respectively. Using CAMS method, the myocardial volume subtended to a stenotic coronary segment (Vsub) was assessed. The primary composites included target vessel-related major adverse cardiac event (MACE) including cardiac death, myocardial infarction, and target vessel revascularization over 3 years. Independent predictors of 3-year MACE in deferred lesions were Vsub (adjusted hazard ratio [HR] 1.02), FFR (adjusted HR per 0.1 = 0.60), and distal reference luminal diameter (adjusted HR 2.04, all p