Work

Integrated CT-derived fractional flow reserve and perivascular fat attenuation index: a multimodal approach to predict in-stent restenosis

Year: 2025

Type: article

Abstract: Background: A significant proportion of patients develop in-stent restenosis (ISR) following percutaneous coronary intervention (PCI) with stent implantation, adversely impacting long-term outcomes. Pericoronary fat attenuation index (FAI) and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) represent emerging non-invasive imaging biomarkers potentially contributing to ISR pathogenesis through inflammatory and hemodynamic mechanisms. Objective: To construct and evaluate an integrated multimodal predictive model integrating non-invasive computed tomography angiography-derived fractional flow reserve (CT-FFR) and pericoronary fat attenuation index (FAI) for assessing drug-eluting stent (DES)-associated ISR. Methods: This retrospective cohort study enrolled 144 patients (225 coronary lesions) undergoing coronary CT angiography (CCTA) between 2020 and 2024, followed by PCI within one month and subsequent angiographic follow-up (either invasive coronary angiography or CCTA). Computed tomography angiography-derived fractional flow reserve (CT-FFR) values for target lesions were reconstructed using deep learning algorithms. Pericoronary FAI was quantified at the stented coronary segment. The primary endpoint was angiographically confirmed in-stent restenosis (ISR, defined as luminal stenosis ≥50%) during follow-up. A hybrid-effects logistic regression model generated the integrated CT-FAI-FFR score. Predictive efficacy was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis. Results: = 0.009). Conclusion: The CT-FAI-FFR score optimizes ISR risk stratification by integrating complementary information reflecting hemodynamic impairment and local vascular inflammation. This finding suggests a potential pathophysiological interplay between perivascular inflammation and hemodynamic impairment in ISR development.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2025.1703044