Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
EuroIntervention. 2019 Oct 4;15(9):e788-e795. doi: 10.4244/EIJ-D-18-00113.
Side branch (SB) occlusion is one of the major technical hurdles in the percutaneous coronary intervention (PCI) of bifurcation lesions. Our aim was to investigate whether preprocedural coronary computed tomography angiography (CCTA) could predict intraprocedural SB occlusion.
A total of 260 bifurcation lesions were enrolled from 246 patients who underwent CCTA before elective bifurcation PCI. Quantitative plaque analysis was performed in the main vessel (MV) and SB. Intraprocedural SB occlusion occurred in 42 lesions (16%). These lesions were characterised by SB plaque, calcified plaque in the MV, low attenuation plaque in the main proximal segment or SB, and a ratio of MV to SB ostium area >4.3, which constituted a point-based CT bifurcation score. The CT bifurcation score was cross-validated, outperforming any angiographic Medina classification or RESOLVE score (c-statistics=0.749 versus 0.631 to 0.551; p<0.05 for all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT bifurcation score ≥1 were 90%, 42%, 23%, 96%, and 50%, respectively.
Comprehensive CCTA assessment was able to predict intraprocedural SB occlusion better than the current angiographic classification or scoring system. The CT bifurcation score may thus be a helpful guide for selecting the optimal bifurcation PCI strategy.
边支（SB）闭塞是经皮冠状动脉介入治疗（PCI）分叉病变的主要技术障碍之一。我们旨在研究冠状动脉计算机断层扫描血管造影术（CCTA）术前是否可以预测术中 SB 闭塞。
共纳入 246 例行选择性分叉 PCI 前接受 CCTA 的患者的 260 个分叉病变。对主血管（MV）和 SB 进行定量斑块分析。42 个病变（16%）术中发生 SB 闭塞。这些病变的特征是 SB 斑块、MV 中的钙化斑块、主近端节段或 SB 中的低衰减斑块，以及 MV 与 SB 开口面积比>4.3，这构成了基于 CT 的分叉评分。CT 分叉评分进行了交叉验证，优于任何血管造影 Medina 分类或 RESOLVE 评分（c 统计=0.749 与 0.631 至 0.551；所有 p<0.05）。CT 分叉评分≥1 的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为 90%、42%、23%、96%和 50%。
综合 CCTA 评估能够比当前的血管造影分类或评分系统更好地预测术中 SB 闭塞。因此，CT 分叉评分可能是选择最佳分叉 PCI 策略的有用指南。
