Grundeken Maik J, Collet Carlos, Ishibashi Yuki, Généreux Philippe, Muramatsu Takashi, LaSalle Laura, Kaplan Aaron V, Wykrzykowska Joanna J, Morel Marie-Angèle, Tijssen Jan G, de Winter Robbert J, Onuma Yoshinobu, Leon Martin B, Serruys Patrick W
Amsterdam Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Catheter Cardiovasc Interv. 2018 Jun;91(7):1263-1270. doi: 10.1002/ccd.27243. Epub 2017 Aug 24.
To compare visual estimation with different quantitative coronary angiography (QCA) methods (single-vessel versus bifurcation software) to assess coronary bifurcation lesions.
QCA has been developed to overcome the limitations of visual estimation. Conventional QCA however, developed in "straight vessels," has proved to be inaccurate in bifurcation lesions. Therefore, bifurcation QCA was developed. However, the impact of these different modalities on bifurcation lesion severity classification is yet unknown METHODS: From a randomized controlled trial investigating a novel bifurcation stent (Clinicaltrials.gov NCT01258972), patients with baseline assessment of lesion severity by means of visual estimation, single-vessel QCA, 2D bifurcation QCA and 3D bifurcation QCA were included. We included 113 bifurcations lesions in which all 5 modalities were assessed. The primary end-point was to evaluate how the different modalities affected the classification of bifurcation lesion severity and extent of disease.
On visual estimation, 100% of lesions had side-branch diameter stenosis (%DS) >50%, whereas in 83% with single-vessel QCA, 27% with 2D bifurcation QCA and 26% with 3D bifurcation QCA a side-branch %DS >50% was found (P < 0.0001). With regard to the percentage of "true" bifurcation lesions, there was a significant difference between visual estimate (100%), single-vessel QCA (75%) and bifurcation QCA (17% with 2D bifurcation software and 13% with 3D bifurcation software, P < 0.0001).
Our study showed that bifurcation lesion complexity was significantly affected when more advanced bifurcation QCA software were used. "True" bifurcation lesion rate was 100% on visual estimation, but as low as 13% when analyzed with dedicated bifurcation QCA software.
比较视觉评估与不同的定量冠状动脉造影（QCA）方法（单支血管与分叉软件），以评估冠状动脉分叉病变。
QCA的开发是为了克服视觉评估的局限性。然而，传统的QCA是在“直血管”中开发的，已被证明在分叉病变中不准确。因此，开发了分叉QCA。然而，这些不同模式对分叉病变严重程度分类的影响尚不清楚。方法：从一项研究新型分叉支架的随机对照试验（Clinicaltrials.gov NCT01258972）中，纳入通过视觉评估、单支血管QCA、二维分叉QCA和三维分叉QCA对病变严重程度进行基线评估的患者。我们纳入了113个分叉病变，对所有5种模式进行了评估。主要终点是评估不同模式如何影响分叉病变严重程度和疾病范围的分类。
在视觉评估中，100%的病变侧支直径狭窄（%DS）>50%，而在单支血管QCA中为83%，二维分叉QCA中为27%，三维分叉QCA中为26%发现侧支%DS>50%（P<0.0001）。关于“真正”分叉病变的百分比，视觉估计（100%）、单支血管QCA（75%）和分叉QCA（二维分叉软件为17%，三维分叉软件为13%）之间存在显著差异（P<0.0001）。
我们的研究表明，使用更先进的分叉QCA软件时，分叉病变的复杂性受到显著影响。视觉评估时“真正”分叉病变率为100%，但使用专用分叉QCA软件分析时低至13%。
