Coronary CT Angiography-Derived Plaque and Hemodynamic Characteristics for In-Stent Restenosis: A Self-Controlled Study.

BACKGROUND: In-stent restenosis (ISR) after percutaneous coronary interventions (PCI) remains a significant challenge. AIMS: This study aimed to investigate the predictive ability of coronary CT angiography (CTA) derived plaque and hemodynamic characteristics for ISR. METHODS: In this retrospective study, we included stable patients who underwent coronary CTA prior to the index PCI and subsequently exhibited both ISR and non-ISR in different stented lesions during follow-up. The plaque and hemodynamic characteristics derived from coronary CTA were assessed. The incremental discriminant and reclassification abilities for ISR prediction were compared among 2 models (model 1: procedural characteristics; model 2: model 1 + plaque characteristics + hemodynamic characteristics). RESULTS: A total of 52 patients with 120 lesions were included in the study, comprising 63 ISR lesions and 57 non-ISR lesions. The average age was 62.6 ± 9.9 years old and 67.3% (35/52) were male. The median interval between index PCI and ISR was 22 (14.3-66.8) months. Compared with non-ISR group, lesions in ISR group exhibited more adverse plaque characteristics (APC) and adverse hemodynamic characteristics (AHC). The risk of developing ISR in lesions with ≥ 2 APC and ≥ 3 AHC was significantly higher than that with < 2 APC and < 3 AHC (HR = 11.02, 95% CI = 1.63-16.32, p = 0.002). The C-index of Model 2 (0.858; 95% CI: 0.782-0.925) was higher than that of Model 1 (0.762; 95% CI: 0.670-0.845) (p = 0.017). CONCLUSIONS: The noninvasive assessment of CTA-derived plaque characteristics and hemodynamic features enhanced the prediction of ISR after PCI in stable patients.