ABSTRACT
OBJECTIVES: This study aims to investigate the differences in plaque characteristics and fat attenuation index (FAI) between in patients who received revascularization versus those who did not receive revascularization and examine whether the machine-learning (ML) based model constructed by plaque characteristics and FAI can predict revascularization. MATERIALS & METHODS: This study was a post hoc analysis of a prospective single-center registry of sequential patients undergoing CCTA, referred from inpatient and emergency department settings (n = 261, 63 years ± 8; 188 men). The primary outcome was revascularization by percutaneous coronary revascularization. The CTA images were analyzed by experienced radiologists using a dedicated workstation in a blinded fashion. The ML-based model was automatically computed. RESULTS: The study cohort consisted of 261 subjects. Revascularization was performed in 105 subjects. Patients receiving revascularization had higher FAI value (67.35±5.49 Hu vs -80.10±7.75 Hu, p < 0.001) as well as higher plaque length, calcified, lipid and fibrous plaque burden and volume. When FAI was incorporated into a ML risk model based on plaque characteristics to predict revascularization, the area under the curve increased from 0.84 (95% CI: 0.68-0.99) to 0.95 (95% CI: 0.88-1.00). CONCLUSION: ML-algorithms based on FAI and characteristics could help improve the prediction of future revascularization and identify patients likely to receive revascularization. ADVANCES IN KNOWLEDGE: Pre-procedural FAI could help guide revascularization in symptomatic CAD patients.
ABSTRACT
BACKGROUND: Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS: This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (5 and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS: The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS: The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.