Author + information
- Received February 17, 2017
- Revision received April 11, 2017
- Accepted April 18, 2017
- Published online May 7, 2018.
- Carlos Collet, MDa,
- Bernard Chevalier, MDb,
- Angel Cequier, MD, PhDc,
- Jean Fajadet, MDd,
- Marcello Dominici, MDe,
- Steffen Helqvist, MDf,
- Ad J. Van Boven, MD, PhDg,
- Dariusz Dudek, MDh,
- Dougal McClean, MDi,
- Manuel Almeida, MDj,
- Jan J. Piek, MD, PhDa,
- Erhan Tenekecioglu, MDk,
- Antonio Bartorelli, MD, PhDl,
- Stephan Windecker, MD, PhDm,
- Patrick W. Serruys, MD, PhDn,∗ ( and )
- Yoshinobu Onuma, MD, PhDk
- aAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- bInstitut Jacques Cartier, Massy, France
- cBellvitge University Hospital, Idibell, Barcelona, Spain
- dClinique Pasteur, Toulouse, France
- eS. Maria University Hospital, Terni, Italy
- fRigshospitalet, University of Copenhagen, Copenhagen, Denmark
- gMedical Center Leeuwarden, Leeuwarden, the Netherlands
- hInstitute of Cardiology, Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
- iChristchurch Hospital, Christchurch, New Zealand
- jHospital Santa Cruz, Carnaxide, Portugal
- kErasmus Medical Center, Rotterdam, the Netherlands
- lCentro Cardiologico Monzino, University of Milan, Milan, Italy
- mUniversitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
- nImperial College of London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Patrick W. Serruys, Imperial College of London, Westblaak 98, Entrance B, 6th Floor, Rotterdam 3012KM, the Netherlands.
Objectives The purpose of this study was to assess the diagnostic accuracy of coronary computed tomography angiography (CTA) for bioresorbable vascular scaffold (BVS) evaluation.
Background Coronary CTA has emerged as a noninvasive method to evaluate patients with suspected or established coronary artery disease. The diagnostic accuracy of coronary CTA to evaluate angiographic outcomes after BVS implantation has not been well established.
Methods In the ABSORB II (A Bioresorbable Everolimus-Eluting Scaffold Versus a Metallic Everolimus-Eluting Stent II) study, patients were randomized either to receive treatment with the BVS or everolimus-eluting metallic stent. At the 3-year follow-up, 238 patients (258 lesions) treated with BVS underwent coronary angiography with intravascular ultrasound (IVUS) evaluation and coronary CTA. The diagnostic accuracy of coronary CTA was assessed by the area under the receiver-operating characteristic curve with coronary angiography and IVUS as references.
Results The mean difference in coronary CTA-derived minimal luminal diameter was −0.14 mm (limits of agreement −0.88 to 0.60) with quantitative coronary angiography as reference, whereas the mean difference in minimal lumen area was 0.73 mm2 (limits of agreement −1.85 to 3.30) with IVUS as reference. The per-scaffold diagnostic accuracy of coronary CTA for detecting stenosis based on coronary angiography diameter stenosis of ≥50% revealed an area under the receiver-operating characteristic curve of 0.88 (95% confidence interval [CI]: 0.82 to 0.92) with a sensitivity of 80% (95% CI: 28% to 99%) and a specificity of 100% (95% CI: 98% to 100%), whereas diagnostic accuracy based on IVUS minimal lumen area ≤2.5 mm2 showed an area under the receiver-operating characteristic curve of 0.83 (95% CI: 0.77 to 0.88) with a sensitivity of 71% (95% CI: 44% to 90%) and a specificity of 82% (95% CI: 75% to 87%). The diagnostic accuracy of coronary CTA was similar to coronary angiography in its ability to identify patients with a significant lesion based on the IVUS criteria (p = 0.75).
Conclusions Coronary CTA has good diagnostic accuracy to detect in-scaffold luminal obstruction and to assess luminal dimensions after BVS implantation. Coronary angiography and coronary CTA yielded similar diagnostic accuracy to identify the presence and severity of obstructive disease. Coronary CTA might become the method of choice for the evaluation of patients treated with BVS.
Dr. Fajadet has received educational grants from Abbott, Boston Scientific, Medtronic, and Terumo. Drs. Dudek, Piek, Serruys, and Onuma are members of the International Advisory Board for Abbott Vascular. Dr. Chevalier is a consultant for Abbott Vascular. Dr. Windecker has received research contracts from Boston Scientific, Biotronik, Bracco, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
H. Vernon Anderson, MD, served as the Guest Editor for this paper.
- Received February 17, 2017.
- Revision received April 11, 2017.
- Accepted April 18, 2017.
- 2018 American College of Cardiology Foundation