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Peer-reviewedCC BYKaohsiung Journal of Medical Sciences

Hemodynamic Significance of APEXCT Coronary Angiography Combined With Dynamic CT Myocardial Perfusion Imaging in Assessing Restenosis After Coronary Stenting

  • Liang‐Shi Wang1
  • Tian Bai1
  • Ji‐Zhou Yan2
  • Peng‐Yu Guan3
  • Li‐Juan Wen1
  • Hong Guo4
  • Tian‐Yu Zhang5
5 affiliations
  1. 1Department of Radiological Imaging Center The Third Affiliated Hospital of Qiqihar Medical University Qiqihar Heilongjiang China
  2. 2Department of Cardiovascular Medicine The Third Affiliated Hospital of Qiqihar Medical University Qiqihar Heilongjiang China
  3. 3Department of Equipment The Third Affiliated Hospital of Qiqihar Medical University Qiqihar Heilongjiang China
  4. 4Department of Radiology The First Hospital of Qiqihar Qiqihar Heilongjiang China
  5. 5Department of Image Center The Second Affiliated Hospital of Qiqihar Medical University Qiqihar Heilongjiang China
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Abstract

This study aimed to evaluate the hemodynamic significance of in‐stent restenosis (ISR) by using a combined anatomical‐functional approach with photon‐counting CT coronary angiography (APEX‐CT CTA) and dynamic CT myocardial perfusion imaging (CT‐MPI). We prospectively enrolled 239 symptomatic patients at least 9 months after PCI. All patients underwent APEX‐CT CTA (assessing diameter stenosis [CTA%DS] and plaque composition) and CT‐MPI (measuring myocardial blood flow [MBF] and relative myocardial blood volume [rMBV]). Invasive coronary angiography (CAG) and fractional flow reserve (FFR) served as the reference standard, with a composite ISR endpoint defined as CAG%DS ≥ 90% or CAG%DS ≥ 50% with FFR ≤ 0.80. Among 239 patients, 41 (17.2%) were ISR‐positive. The ISR‐positive group had significantly higher CTA%DS, lipid plaque proportion, diabetes prevalence, and smaller/longer stents, but lower MBF and rMBV. Multivariate analysis identified CTA%DS (OR = 6.801, 95% CI: 3.014–15.346) and rMBV > 0.7 (OR = 0.231, 95% CI: 0.079–0.673) as independent predictors, and their combination yielded an AUC of 0.949. In conclusion, APEX‐CT CTA combined with CT‐MPI enables dual anatomical‐functional assessment of ISR, with CTA%DS and rMBV serving as key noninvasive indicators, though further validation of its long‐term applicability and generalizability is warranted.

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Cite

BibTeXRIS
BibTeX
@article{wang2026hemodynamic,
  title = {{Hemodynamic Significance of APEXCT Coronary Angiography Combined With Dynamic CT Myocardial Perfusion Imaging in Assessing Restenosis After Coronary Stenting}},
  author = {Liang‐Shi Wang and Tian Bai and Ji‐Zhou Yan and Peng‐Yu Guan and Li‐Juan Wen and Hong Guo and Tian‐Yu Zhang},
  journal = {Kaohsiung Journal of Medical Sciences},
  year = {2026},
  month = nov,
  doi = {10.1002/kjm2.70213},
  url = {https://doi.org/10.1002/kjm2.70213},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Hemodynamic Significance of APEXCT Coronary Angiography Combined With Dynamic CT Myocardial Perfusion Imaging in Assessing Restenosis After Coronary Stenting
AU  - Liang‐Shi Wang
AU  - Tian Bai
AU  - Ji‐Zhou Yan
AU  - Peng‐Yu Guan
AU  - Li‐Juan Wen
AU  - Hong Guo
AU  - Tian‐Yu Zhang
PY  - 2026
DA  - 2026/11/06
JO  - Kaohsiung Journal of Medical Sciences
DO  - 10.1002/kjm2.70213
UR  - https://doi.org/10.1002/kjm2.70213
AB  - This study aimed to evaluate the hemodynamic significance of in‐stent restenosis (ISR) by using a combined anatomical‐functional approach with photon‐counting CT coronary angiography (APEX‐CT CTA) and dynamic CT myocardial perfusion imaging (CT‐MPI). We prospectively enrolled 239 symptomatic patients at least 9 months after PCI. All patients underwent APEX‐CT CTA (assessing diameter stenosis [CTA%DS] and plaque composition) and CT‐MPI (measuring myocardial blood flow [MBF] and relative myocardial blood volume [rMBV]). Invasive coronary angiography (CAG) and fractional flow reserve (FFR) served as the reference standard, with a composite ISR endpoint defined as CAG%DS ≥ 90% or CAG%DS ≥ 50% with FFR ≤ 0.80. Among 239 patients, 41 (17.2%) were ISR‐positive. The ISR‐positive group had significantly higher CTA%DS, lipid plaque proportion, diabetes prevalence, and smaller/longer stents, but lower MBF and rMBV. Multivariate analysis identified CTA%DS (OR = 6.801, 95% CI: 3.014–15.346) and rMBV > 0.7 (OR = 0.231, 95% CI: 0.079–0.673) as independent predictors, and their combination yielded an AUC of 0.949. In conclusion, APEX‐CT CTA combined with CT‐MPI enables dual anatomical‐functional assessment of ISR, with CTA%DS and rMBV serving as key noninvasive indicators, though further validation of its long‐term applicability and generalizability is warranted.
SN  - 2410-8650
SN  - 1607-551X
ER  -