Comparison of Computed Tomography Angiography Versus Invasive Angiography to Assess Medina Classification in Coronary Bifurcations

Grodecki, Kajetan; Opolski, Maksymilian P.; Staruch, Adam D.; Michałowska, Anna; Kępka, Cezary; Wolny, Rafał; Pręgowski, Jerzy; Kruk, Mariusz; Dębski, Mariusz; Dębski, Artur; Michałowska, Ilona; Witkowski, Adam

doi:10.1016/j.amjcard.2020.02.026

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…In line with prior studies, we identified the presence of coronary plaque in SB as a robust predictor of its occlusion [2,15,[31][32][33][34]. In our recent paper on CTA-derived RESOLVE score, diameter stenosis of SB before MV stenting and pre-procedural diameter stenosis of bifurcation core achieved the highest diagnostic accuracies for predicting SB occlusion (AUC of 0.720 and 0.725, respectively) [4].…”

Section: Discussionsupporting

confidence: 80%

Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry

et al. 2020

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Objectives To assess the incremental value of quantitative plaque features measured from computed tomography angiography (CTA) for predicting side branch (SB) occlusion in coronary bifurcation intervention. Methods We included 340 patients with 377 bifurcation lesions in the post hoc analysis of the CT-PRECISION registry. Each bifurcation was divided into three segments: the proximal main vessel (MV), the distal MV, and the SB. Segments with evidence of coronary plaque were analyzed using semi-automated software allowing for quantitative analysis of coronary plaque morphology and stenosis. Coronary plaque measurements included calcified and noncalcified plaque volumes, and corresponding burdens (respective plaque volumes × 100%/vessel volume), remodeling index, and stenosis. Results SB occlusion occurred in 28 of 377 bifurcation lesions (7.5%). The presence of visually identified plaque in the SB segment, but not in the proximal and distal MV segments, was the only qualitative parameter that predicted SB occlusion with an area under the curve (AUC) of 0.792. Among quantitative plaque parameters calculated for the SB segment, the addition of noncalcified plaque burden (AUC 0.840, p = 0.003) and low-density plaque burden (AUC 0.836, p = 0.012) yielded significant improvements in predicting SB occlusion. Using receiver operating characteristic curve analysis, optimal cut-offs for noncalcified plaque burden and low-density plaque burden were > 33.6% (86% sensitivity and 78% specificity) and > 0.9% (89% sensitivity and 73% specificity), respectively. Conclusions CTA-derived noncalcified plaque burden, when added to the visually identified SB plaque, significantly improves the prediction of SB occlusion in coronary bifurcation intervention. Trial registration ClinicalTrials.gov Identifier: NCT03709836 registered on October 17, 2018.

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Section: Discussionsupporting

confidence: 80%

Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry

et al. 2020

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“…In this context, the visual CTA-derived V-RESOLVE score is yet another predictor (after quantitative CTA-derived RESOLVE score, Medina class with any involvement of the proximal MV and SB plaque, and the presence of any plaque within the first 5 mm of SB segment on coronary CTA) of SB occlusion in coronary bifurcation intervention. 20,21 Discriminative Performance of CTA-derived V-RESOLVE Score Our data confirmed the ability of CTA-derived V-RESOLVE score to stratify lesions into high-risk group and non-high-risk group of SB occlusion. Specifically, by using the cutoff value of 17 points (defined as the lowest score in quartile 4) for discrimination between high-risk group ( ≥ 17) and non-highrisk group (< 17), the incidence of SB occlusion was significantly higher in the high-risk group (18.6%) than in the non-high-risk group (3.8%).…”

Section: Predictive Accuracy Of Cta-derived V-resolve Scoresupporting

confidence: 76%

“…In this regard, our findings compare equally with earlier studies on the ability of the angiography-based V-RESOLVE score to predict SB occlusion during coronary bifurcation intervention (with AUC ranging from 0.75 to 0.80), and further extend the utility of coronary CTA for guiding PCI. In this context, the visual CTA-derived V-RESOLVE score is yet another predictor (after quantitative CTA-derived RESOLVE score, Medina class with any involvement of the proximal MV and SB plaque, and the presence of any plaque within the first 5 mm of SB segment on coronary CTA) of SB occlusion in coronary bifurcation intervention 20,21…”

Section: Discussionmentioning

confidence: 99%

Visually Estimated RESOLVE Score Based on Coronary Computed Tomography to Predict Side Branch Occlusion in Percutaneous Bifurcation Intervention

Michałowska

Grodecki

Staruch

et al. 2021

Journal of Thoracic Imaging

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“…Several studies have compared the anatomical SYNTAX score derived from CCTA and ICA and rea rmed thatits calculation using CCTA is reasonably accurate and reproducible, especially in non-complex patients [5,[18][19][20] , however some discordance between the two has been seen in heavy calci ed plaque and the Medina classi cation of bifurcation lesions [21][22][23] . The present study also showed comparable total anatomical SYNTAX scores between the two modalities, as the tendency for CCTA to overestimate the severity of stenosis-due to the blooming effect of calcium-and the resulting increased number of lesions was tempered by ICA identifying more lesions >20 mm, more trifurcation lesions (due to the lack of the optimal angiographic view)and more severe tortuosity (due to the two-dimensional perception of the tortuosity).…”

Section: Discussionmentioning

confidence: 99%

Treatment Recommendation Based on SYNTAX score 2020 Derived from Coronary Computed Tomography Angiography and Invasive Coronary Angiography

Masuda

Serruys

Kageyama

et al. 2023

Preprint

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Purpose The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). Methods This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] – [predicted CABG mortality]). The level of agreement was evaluated with Bland-Altman plots and Cohen’s Kappa. Results The mean age was 66.2±9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1±11.5 and 35.6±11.4 (p=0.751), respectively. The Bland-Altman analysis showed mean differences of -0.26 and -0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen’s κ coefficients of 0.672 and 0.551. Conclusion There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.

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Comparison of Computed Tomography Angiography Versus Invasive Angiography to Assess Medina Classification in Coronary Bifurcations

Cited by 10 publications

References 28 publications

Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry

Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry

Visually Estimated RESOLVE Score Based on Coronary Computed Tomography to Predict Side Branch Occlusion in Percutaneous Bifurcation Intervention

Treatment Recommendation Based on SYNTAX score 2020 Derived from Coronary Computed Tomography Angiography and Invasive Coronary Angiography

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