Photon-Counting Cardiac CT in Post-PCI Patients

Overview

This study takes patients who have undergone percutaneous coronary intervention as the research subjects and employs a prospective observational cohort design, aiming to develop and validate a "one-stop" photon-counting computed tomography imaging framework. The one-stop PCCT protocol implies that multiple assessments are acquired through a single examination, including coronary CT angiography for stent and native artery evaluation, resting first-pass myocardial iodine distribution imaging, and delayed myocardial extracellular volume quantification, with cardiac cine imaging performed in a prespecified dose-controlled substudy.

In the long-term management of patients after percutaneous coronary intervention, imaging assessment has become an indispensable tool for detecting in-stent restenosis, progression of native coronary artery disease, myocardial ischemia, and adverse ventricular remodeling. Current guidelines recommend various imaging modalities, including coronary CT angiography for stent and vessel evaluation, stress perfusion imaging for myocardial ischemia, and cardiac magnetic resonance for tissue characterization and ventricular function. However, traditional follow-up strategies require multiple separate examinations, which entail repeated contrast agent administration, cumulative radiation exposure, prolonged diagnostic timelines, and fragmented pathophysiological assessment. How to simultaneously evaluate coronary anatomy, myocardial iodine distribution, extracellular volume, and cardiac function through a single examination is a major clinical need that remains to be addressed. This study takes patients who have undergone percutaneous coronary intervention as the research subjects and adopts a prospective observational cohort design. The aim is to innovatively develop and validate a "one-stop" photon-counting computed tomography imaging framework. The PCCT ONE-STEP protocol implies that multiple assessments are acquired through a single intravenous contrast injection and a single examination visit, including ultra-high-resolution coronary CT angiography for stent and native artery evaluation, spectral first-pass myocardial iodine distribution imaging, and low-dose delayed myocardial extracellular volume quantification. In a prespecified dose-controlled substudy, cardiac cine imaging and CT-derived strain analysis are additionally obtained. The PCCT ONE-STEP protocol leverages the intrinsic spectral sensitivity and high spatial resolution of photon-counting detector technology. It can reduce the total volume of iodinated contrast medium and cumulative radiation dose compared with the sum of separate diagnostic examinations, while preserving or expanding the imaging content. By providing integrated coronary, myocardial iodine, extracellular volume, and functional phenotypes at a single visit, it has the potential to shorten the diagnostic work-up, decrease the incidence of contrast-associated adverse events, and improve patient throughput. The acquisition of multiple key imaging indicators enables individualized comprehensive assessment of post-PCI patients, supports the investigation of biological relevance through associations with circulating biomarkers, and facilitates the prediction of clinical ischemic and heart failure-related outcomes. The implementation of this study is expected to optimize the imaging pathway in the long-term care of patients after percutaneous coronary intervention.