CT-derived Virtual Stenting Optimize Coronary Revascularization (CT-COMPASS)
Status: Not yet recruiting

A considerable number of patients presented with anatomically successful PCI results still suffer from functionally unresolved ischemia, which might be the cause for over one-fourth of patients experiencing recurrent angina at 1 year or adverse events at 2 years. Currently, the post-PCI physiology measurement is one of the effective metrics to quantify residual ischemia, and a suboptimal post-PCI result is strongly associated with worse outcomes. However, PCI optimization based on post-PCI physiology is, to certain extent, a provisional rescue action for a suboptimal index procedure, which may not be fully correctable "after the fact" given selected stents, site of deployment and procedural technique.

Computed tomography (CT) coronary physiology-derived virtual stenting (CT-VS) based on pre-PCI CCTA angiograms is an augmented reality (AR) approach that simulates the post-stenting physiology assuming that the specified segment of the treated vessel is successfully dilated by implanting virtual stents. Previous studies have demonstrated the feasibility of optimizing PCI with CT-VS, with high consistency between pre-PCI simulated physiology result by CT-VS and actual post-PCI physiology results. Therefore, the application of CT-VS would help physicians to develop the best strategies while planning the procedure.

However, there is a lack of knowledge regarding the efficacy of this novel physiological index that is available pre-PCI in achieving final post-PCI optimal physiological result. The Trials of "Computed Tomography Coronary Physiology-derived Virtual Stenting Guided Revascularization Strategy in Patients with Coronary Artery Disease (CT-COMPASS)" was designed to assess the efficacy of a CT-VS vs. standard angiographic guidance in achieving post-PCI optimal physiological result (post-PCI FFR≥0.90).

Eligibility:
- EligibilityCriteria: Inclusion Criteria  General Inclusion Criteria  Age ≥ 18 years. Able to understand the trial design and provide written informed consent. Patients with a coronary CTA performed within 30 days.  CCTA Inclusion Criteria  The CCTA angiograms amenable to CT-FFR measurement. At least 1 lesion of 50%-90% diameter stenosis in a coronary artery with ≥2.0mm reference vessel diameter by visual assessment. And this target vessel is of physiological ischemia as assessed by CT-FFR.  Angiographic Inclusion Criteria  1. The interrogated vessel is indicated for intervention assessed by operator based on indications other than CT-FFR.  Exclusion Criteria  General Exclusion Criteria  Cardiogenic shock or severe heart failure (NYHA ≥III or LVEF<30%). Severely impaired renal function: creatinine >150μmol/L or Cockcroft-Gault calculated GFR <45 ml/kg/1.73 m2 (calculated with Cockcroft-Gault formula). Allergy to iodine-containing contrast agents which cannot be adequately premedicated.  CCTA Exclusion Criteria  The CCTA angiograms deems not amenable to CT-FFR measurement. Patients with only 1 coronary artery lesion with DS >90% with TIMI flow <3. An interrogated vessel presented with a CTO lesion. All coronary arteries were not physiologically ischemic. Coronary lesions favor CABG treatment.  Angiographic Exclusion Criteria  The interrogated vessel with only 1 coronary artery lesion with DS >90% with TIMI flow <3. Coronary lesions favor CABG treatment. - HealthyVolunteers: No - Gender: All - MinimumAge: 18 Years - StdAgeList: Adult, Older Adult