1
|
Zimarino M, Barbato E, Nakamura S, Radico F, Di Nicola M, Briguori C, Gil RJ, Kanic V, Perfetti M, Pellicano M, Mairic K, Stankovic G. The impact of the extent of side branch disease on outcomes following bifurcation stenting. Catheter Cardiovasc Interv 2020; 96:E84-E92. [PMID: 32150341 DOI: 10.1002/ccd.28842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/25/2020] [Accepted: 02/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To define the impact of side branch (SB) lesion length on clinical outcomes after percutaneous coronary intervention (PCI) on bifurcation lesions. BACKGROUND The role of the SB lesion length remains questionable in PCI planning and its implication on clinical outcome is controversial. METHODS Data from the retrospective multicenter EBC-P2BiTO registry were analyzed. The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction excluding periprocedural, or stent thrombosis at 13 months median follow-up (IQR 11-28). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding. RESULTS Among 1,252 patients, SB was normal in 489 (39%), diseased in 763 (61%) cases. MACE occurred in 68 patients (5.4%). The optimal discriminant SB lesion length for MACE was ≥10 mm, with an area under the curve of 0.71 (p < .01). The incidence of MACE was higher among patients with SB lesions ≥10 mm (8%) than with normal SB (4.1%) (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.5-5.3; p = .001, IPTW-adjusted) or SB lesions <10 mm (5.1%) (HR, 1.5; 95% CI, 1.1-3.3; p = .048, IPTW-adjusted), being similar between these last two groups. CONCLUSIONS In bifurcation PCI, SB lesion length ≥ 10 mm identifies patients at higher risk of MACE than those with <10 mm SB lesions and those without SB disease, considering that no differences were observed among these last two groups. Careful planning is mandatory when approaching bifurcations with long SB lesions.
Collapse
Affiliation(s)
- Marco Zimarino
- Institute of Cardiology "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy.,Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Francesco Radico
- Institute of Cardiology "G. d'Annunzio" University Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics "G. d'Annunzio", Chieti, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Robert J Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Vojko Kanic
- Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia
| | | | - Mariano Pellicano
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Kristina Mairic
- Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | |
Collapse
|
2
|
Cao Y, Mintz GS, Matsumura M, Zhang W, Lin Y, Wang X, Fujino A, Lee T, Murai T, Hoshino M, Usui E, Kanaji Y, Yonetsu T, Kakuta T, Maehara A. The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion after Provisional Stenting of Coronary Bifurcation Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1007-1013. [PMID: 30683562 DOI: 10.1016/j.carrev.2018.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Layered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting. METHODS This is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying tissue. RESULTS Overall, 207 patients with stable coronary disease were included. SB occlusion occurred in 26/207 (12.6%) bifurcation lesions. Operators decided not to perform additional treatment, and TIMI flow did not improve to ≥2 in cases with SB occlusion. The prevalence of OCT-detected layered pattern was more common in lesions with versus without SB occlusion (88.5% versus 33.7%, p < 0.0001); OCT-detected layered pattern was more often located on the same side of the SB (73.9% versus 21.3%, p < 0.0001) circumferentially compared to lesions without SB occlusion. Multivariable analysis showed that OCT-detected layered pattern was an independent predictor of SB occlusion (odds ratio 18.8, 95% confidence interval 5.1-68.8, p < 0.0001) along with true bifurcation lesion and wider angiographic bifurcation angle. CONCLUSIONS The presence of an OCT-detected layered pattern near its ostium was a strong predictor of SB occlusion after provisional bifurcation stenting.
Collapse
Affiliation(s)
- Yang Cao
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Wenbin Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongqing Lin
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Xiao Wang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Akiko Fujino
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
3
|
Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
Collapse
Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | |
Collapse
|
4
|
Grundeken MJ, Collet C, Ishibashi Y, Généreux P, Muramatsu T, LaSalle L, Kaplan AV, Wykrzykowska JJ, Morel MA, Tijssen JG, de Winter RJ, Onuma Y, Leon MB, Serruys PW. Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions. Catheter Cardiovasc Interv 2017; 91:1263-1270. [DOI: 10.1002/ccd.27243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/21/2017] [Accepted: 07/20/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Maik J. Grundeken
- Amsterdam Heart Center, Academic Medical Center; Amsterdam The Netherlands
| | - Carlos Collet
- Amsterdam Heart Center, Academic Medical Center; Amsterdam The Netherlands
| | - Yuki Ishibashi
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Philippe Généreux
- Cardiovascular Research Foundation; New York
- Columbia University Medical Center; New York
- Morristown Medical Center; Morristown New Jersey
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal; Montréal Québec Canada
| | - Takashi Muramatsu
- Department of Cardiology; Fujita Health University Hospital; Toyoake Japan
| | | | - Aaron V. Kaplan
- Geisel School of Medicine/Dartmouth-Hitchcock Medical Center; New Hampshire Lebanon
| | | | | | - Jan G. Tijssen
- Amsterdam Heart Center, Academic Medical Center; Amsterdam The Netherlands
- Cardialysis B.V; Rotterdam The Netherlands
| | | | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis B.V; Rotterdam The Netherlands
| | - Martin B. Leon
- Cardiovascular Research Foundation; New York
- Columbia University Medical Center; New York
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London; United Kingdom
| |
Collapse
|
5
|
Collet C, Onuma Y, Cavalcante R, Grundeken M, Généreux P, Popma J, Costa R, Stankovic G, Tu S, Reiber JHC, Aben JP, Lassen JF, Louvard Y, Lansky A, Serruys PW. Quantitative angiography methods for bifurcation lesions: a consensus statement update from the European Bifurcation Club. EUROINTERVENTION 2017; 13:115-123. [PMID: 28067200 DOI: 10.4244/eij-d-16-00932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bifurcation lesions represent one of the most challenging lesion subsets in interventional cardiology. The European Bifurcation Club (EBC) is an academic consortium whose goal has been to assess and recommend the appropriate strategies to manage bifurcation lesions. The quantitative coronary angiography (QCA) methods for the evaluation of bifurcation lesions have been subject to extensive research. Single-vessel QCA has been shown to be inaccurate for the assessment of bifurcation lesion dimensions. For this reason, dedicated bifurcation software has been developed and validated. These software packages apply the principles of fractal geometry to address the "step-down" in the bifurcation and to estimate vessel diameter accurately. This consensus update provides recommendations on the QCA analysis and reporting of bifurcation lesions based on the most recent scientific evidence from in vitro and in vivo studies and delineates future advances in the field of QCA dedicated bifurcation analysis.
Collapse
Affiliation(s)
- Carlos Collet
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Grundeken MJ, Garcia-Garcia HM, Kumsars I, Lesiak M, Kayaert P, Dens J, Stella PR, de Winter RJ, Laak LL, Généreux P, Kaplan AV, Leon MB, Wykrzykowska JJ, Onuma Y, Serruys PW. Segmental comparison between a dedicated bifurcation stent and balloon angioplasty using intravascular ultrasound and three-dimensional quantitative coronary angiography: A subgroup analysis of the Tryton IDE randomized trial. Catheter Cardiovasc Interv 2016; 89:E53-E63. [DOI: 10.1002/ccd.26527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/27/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Maik J. Grundeken
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | - Hector M. Garcia-Garcia
- Cardialysis B.V, Rotterdam; Rotterdam The Netherlands
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Maciej Lesiak
- Karol Marcinkowski University of Medical Sciences; Poznan Poland
| | | | - Jo Dens
- Department of Cardiology; ZOL Ziekenhuis Oost-Limburg; Genk Belgium
| | | | - Robbert J. de Winter
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | | | - Philippe Généreux
- Columbia University Medical Center/NewYork Presbyterian Hospital; New York New York
- Hôpital du Sacré-Coeur de Montréal; Montréal Québec Canada
| | - Aaron V. Kaplan
- Tryton Medical; Newton Massachusetts
- Dartmouth Medical School/Dartmouth-Hitchcock Medical Center; NH Lebanon
| | - Martin B. Leon
- Columbia University Medical Center/NewYork Presbyterian Hospital; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Joanna J. Wykrzykowska
- The Heartcenter; Academic Medical Center - University of Amsterdam; Amsterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis B.V, Rotterdam; Rotterdam The Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI; Imperial College London; London United Kingdom
| |
Collapse
|
7
|
Zhang YJ, Zhu H, Shi SY, Muramatsu T, Pan DR, Ye F, Zhang JJ, Tian NL, Bourantas CV, Chen SL. Comparison between two-dimensional and three-dimensional quantitative coronary angiography for the prediction of functional severity in true bifurcation lesions: Insights from the randomized DK-CRUSH II, III, and IV trials. Catheter Cardiovasc Interv 2016; 87 Suppl 1:589-98. [PMID: 26876688 DOI: 10.1002/ccd.26405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study investigated the diagnostic accuracy of three-dimensional quantitative coronary angiography (3D-QCA) compared with conventional 2D-QCA for predicting functional severity assessed by fractional flow reserve (FFR) for true bifurcation lesions. METHODS Based on pooled data from the randomized DK-CRUSH II, III, and IV trials, we evaluated the patients with true bifurcation lesions who underwent coronary angiography together with functional evaluations using FFR in both the main vessel and the side branch. Off-line 2D- and 3D-QCA analyses were conducted using dedicated bifurcation QCA analysis software. Measurements of minimum lumen diameter (MLD), percentage diameter stenosis (% DS), and minimum lumen area (MLA) were compared between 2D- and 3D-QCA, and we evaluated their predictive values of functionally significant FFR. RESULTS Ninety patients were eligible for enrollment in the present study. In the main vessel, MLA measured by 3D-QCA was the most accurate predictor of FFR <0.75 (C statistic 0.85, P < 0.001), while MLD measured by 2D-QCA was a similarly accurate predictor (C statistic 0.85, P < 0.001). In the side branch, the best metrics for predicting FFR <0.75 were % DS measured by 2D-QCA with a C statistic value of 0.91 (P < 0.001) and MLA measured by 3D-QCA with a C statistic value of 0.81 (P < 0.001). However, both 2D- and 3D-QCA metrics exhibited low accuracies for predicting FFR <0.75 in intermediate bifurcation lesions. CONCLUSIONS 3D-QCA analysis for true bifurcation lesions did not improve the predictive accuracy of functionally significant FFR compared with 2D-QCA analysis. In lesions with intermediate stenosis, the diagnostic performance of both 2D- and 3D-QCA-derived measurements in differentiating functional severity is limited.
Collapse
Affiliation(s)
- Yao-Jun Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shun-Yi Shi
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Dao-Rong Pan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Christos V Bourantas
- Department of Cardiology, University College London Hospitals, London, United Kingdom
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|