Assessing coronary stenosis. Quantitative coronary angiography versus visual estimation from cine-film or pharmacological stress perfusion images

Background. We investigated whether or not the addition of myocardial mass at risk (MMAR) to quantitative coronary angiography was useful for diagnosing functionally significant coronary stenosis in the daily practice. Methods. We retrospectively enrolled 111 consecutive patients with 149 lesions who underwent clinically indicated coronary computed tomography angiography and subsequent elective coronary angiography with fractional flow reserve (FFR) measurement. MMAR was calculated using a workstation-based software program with ordinary thin slice images acquired for the computed tomography, and the minimal lumen diameter (MLD) and the diameter stenosis were measured with quantitative coronary angiography. Results. The MLD and MMAR were significantly correlated with the FFR, and the MMAR-to-MLD ratio (MMAR/MLD) showed a good correlation. The area under the receiver operating characteristic curve (AUC) of MMAR/MLD for FFR ≤ 0.8 was 0.746, and the sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 83%, 68%, and 77%, respectively, at a cut-off value of 29.5 ml/mm. The addition of MMAR/MLD to diameter stenosis thus made it possible to further discriminate lesions with FFR ≤ 0.8 (AUC = 0.750). For the proximal left coronary artery lesions, in particular, MMAR/MLD showed a better correlation with the FFR, and the AUC of MMAR/MLD for FFR ≤ 0.8 was 0.919 at a cut-off value of 31.7 ml/mm. Conclusions. The index of MMAR/MLD correlated well with the physiological severity of coronary stenosis and showed good accuracy for detecting functional significance. The MMAR/MLD might be a useful parameter to consider when deciding the indication for revascularization.

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Comparison of visual assessment of coronary stenosis with independent quantitative coronary angiography: Findings from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial

American Heart Journal ◽

10.1016/j.ahj.2016.10.014 ◽

2017 ◽

Vol 184 ◽

pp. 1-9 ◽

Cited By ~ 9

Author(s):

Rohan Shah ◽

Eric Yow ◽

William Schuyler Jones ◽

Louis P. Kohl ◽

Andrzej S. Kosinski ◽

...

Keyword(s):

Chest Pain ◽

Coronary Angiography ◽

Coronary Stenosis ◽

Imaging Study ◽

Quantitative Coronary Angiography ◽

Visual Assessment

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Accuracy of 3-dimensional and 2-dimensional quantitative coronary angiography for predicting physiological significance of coronary stenosis: a FAVOR II substudy

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2019.09.07 ◽

2019 ◽

Vol 9 (5) ◽

pp. 481-491

Author(s):

Daixin Ding ◽

Junqing Yang ◽

Jelmer Westra ◽

Yundai Chen ◽

Yunxiao Chang ◽

...

Keyword(s):

Coronary Angiography ◽

Coronary Stenosis ◽

Quantitative Coronary Angiography ◽

Physiological Significance ◽

3 Dimensional

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Revascularization decisions in patients with stable angina and intermediate lesions: results of the second International Survey on Interventional Strategy (ISIS-2)

European Heart Journal ◽

10.1093/ehjci/ehaa946.1407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Toth ◽

W Wijns ◽

S Fournier ◽

B Toth ◽

N Johnson ◽

...

Keyword(s):

Coronary Angiography ◽

Coronary Stenosis ◽

Diagnostic Method ◽

Quantitative Coronary Angiography ◽

Diagnostic Tools ◽

Funding Source ◽

Private Company ◽

Web Based ◽

Stenosis Severity ◽

Coronary Syndromes

Abstract Background ISIS-1 survey (conducted in 2012–2013) demonstrated a significant disconnect between guideline recommendations on invasive functional and imaging assessment of coronary stenosis severity and effective intention to adoption in patients with chronic coronary syndromes (CCS). Ever since, more evidences and new indexes/tools have become available, supposedly resulting into a simplified adoption. Therefore, six years later the second survey was repeated (ISIS-2) with the aim to evaluate a possible evolution in the intended adoption of invasive diagnostic tools. Methods ISIS-2 was conducted via a web-based platform from June to December 2019. Here, five complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography (QCA) values were known and kept concealed to the participants. Estimation of stenosis significance was asked for each lesion. In case of uncertainty, the most appropriate adjunctive invasive diagnostic method among QCA, intravascular ultrasound, optical coherence tomography, or invasive functional test (i.e. with FFR or a non-hyperemic index) was to be selected. Primary endpoint of the study was the rate of requested adjunctive functional or imaging assessment, as indicated by guideline recommendations. Secondary endpoint was the rate and accuracy of purely angiography-based decisions. Results A total of 411 participants performed 3749 lesion evaluations in ISIS-2: 2237 (60%) decisions were taken solely on angiogram and expressed no need for further evaluation with adjunctive tools. This rate of angiographic reliance was significantly reduced in ISIS-2 as compared with ISIS-1 (3139 [71%]; p<0.001). Here the decision (significant or non-significant) was discordant with the known functional significance in 870 (39%) cases, markedly less as in ISIS-1 (1459, 46%; p<0.001). In ISIS-2, participants expressed the need for either invasive functional assessment or intravascular imaging in 1110 (29%) and 379 (11%) cases, respectively. These rates were significantly higher as compared with ISIS-1 (928 [21%]; p<0.001 and 354 [8%]; p<0.001, respectively). Conclusions ISIS-2 survey suggests an evolving pattern over 6 years in the intention to integrate coronary angiography with invasive coronary physiology and imaging testing in patients with CCS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Unrestricted grant from Abbott Medical

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