TCT-516 Cumulative Plaque Burden Analysis for Phenotyping Epicardial Coronary Artery Disease

Abstract

Background
Intravascular ultrasound (IVUS) shows the location and burden of coronary plaques. However, plaque analyses are typically limited to the segment level, preventing the characterization of vessel-level CAD patterns based on plaque distribution, which impacts clinical outcomes. We aimed to characterize and correlate the morphologic and physiologic patterns of CAD through quantitative IVUS analysis.

Methods
In this ASET JAPAN trial subanalysis, pre– and post–percutaneous coronary intervention (PCI) ultrasonic flow ratio (UFR) was analyzed. The percentage plaque burden (PB) of each millimeter on pre-PCI IVUS was quantified, and the cumulative plaque burden (CPB) curves were created. To characterize coronary morphologic patterns, the CPB index (CPBi) was calculated, based on the filtered CPB curves (PB <40%) (Figure 1A).

Results
A total of 130 vessels (8,101 mm) from 123 patients were analyzed. The CPBi of 0.45 (Q1-Q3: 0.32-0.58) correlated well with the UFR-derived pressure pullback gradient index (PPGi) of 0.42 (Q1-Q3: 0.34-0.52; r = 0.64; P < 0.001; Figure 1B). Compared with vessels in the first tertile of CPBi (<0.36), vessels within the third tertile CPBi (≥0.56) had significantly higher percentage atheroma volume (0.54 [Q1-Q3: 0.50-0.59] vs 0.43 [Q1-Q3: 0.39-0.48]; P < 0.001) and received longer stents (28.0 mm [Q1-Q3: 24.0-34.0] vs 20.0 mm [Q1-Q3: 16.0-28.0]; P < 0.001). ROC curve analysis showed that the CPBi was numerically superior to PPGi for predicting post-PCI UFR ≥0.91 (Figure 1C).

Conclusions
CPB analysis offers clinicians an individualized tool to guide PCI based on CAD morphologic patterns.