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Yu X, Wang Y, Zhang W, Wang X, Jia N, Zhang Y, Yang C, Li P, Xu F, Ji F. Establishment of a Nomogram for Predicting the Suboptimal Angiographic Outcomes of Coronary De Novo Lesions Treated with Drug-Coated Balloons. Adv Ther 2023; 40:975-89. [PMID: 36583823 DOI: 10.1007/s12325-022-02400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Factors affecting the angiographic outcomes of coronary de novo lesions treated with drug-coated balloons (DCBs) have not been well illustrated. The aim of the study is to establish a nomogram for predicting the risk of suboptimal diameter stenosis (DS) at angiographic follow-up. METHODS A retrospective analysis was performed on a cohort of patients who underwent DCB intervention for coronary de novo lesions with angiographic follow-up data. Multivariable logistic regression analysis was applied to determine the independent predictors of DS ≥ 30% at follow-up, and then a nomogram model was established and validated. RESULTS A total of 196 patients (313 lesions) were divided into the suboptimal (DS ≥ 30%) and optimal (DS < 30%) DS groups according to quantitative coronary angiography (QCA) measurements of the target lesions at follow-up. Seven independent factors including calcified lesions, true bifurcation lesions, immediate lumen gain rate (iLG%) < 20%, immediate diameter stenosis (iDS) ≥ 30%, DCB diameter/reference vessel diameter ratio (DCB/RVD) < 1.0, DCB length and mild dissection were identified. The area under the curve (AUC) (95% CI) of the receiver-operating characteristic (ROC) curve of the nomogram was 0.738 (0.683, 0.794). After the internal validation, the AUC (95% CI) was 0.740 (0.685, 0.795). The Hosmer-Lemeshow goodness of fit (GOF) test (χ2 = 6.57, P = 0.766) and the calibration curve suggested a good predictive consistency of the nomogram. CONCLUSIONS The well-calibrated nomogram could efficiently predict the suboptimal angiographic outcomes at follow-up. This model may be helpful to optimize lesion preparation to achieve optimal outcomes.
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Kasinadhuni G, Batta A, Gawalkar AA, Budakoty S, Gupta A, Vijayvergiya R. Validity and correlation of quantitative flow ratio with fractional flow reserve for assessment of intermediate coronary lesions. Acta Cardiol 2023; 78:91-98. [PMID: 35382706 DOI: 10.1080/00015385.2022.2059857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The angiographic percent diameter stenosis (%DS) do not assess the physiological significance of epicardial coronary stenosis. The currently practised physiological indices require pressure wires with or without adenosine-induced hyperaemia. Quantitative flow ratio (QFR) is an angiography-based method to determine the functional significance of coronary stenosis. The present study aimed to analyse the diagnostic performance of QFR in comparison to fractional flow reserve (FFR) in intermediate coronary lesions. MATERIALS AND METHODS It was a single centre retrospective study to analyse the diagnostic performance of offline QFR with the previously performed FFR in the last six years. A total of 56 interrogated vessels were included for the analysis. Offline QFR analysis was performed and correlated with FFR values in the intermediate coronary stenoses. RESULTS The mean age of the study population was 62.4 ± 9.1 years, including 81% men. The left anterior descending artery (50%) was the most common analysed vessel followed by left circumflex (27%) and right coronary (21%) arteries. The mean % DS and % area stenosis were 45.25 ± 11.22% and 57.45% ± 16.25%, respectively. The mean FFR and QFR values were 0.83 ± 0.06 and 0.82 ± 0.10, respectively. A strong positive correlation was found between FFR and QFR with a Spearman correlation coefficient of 0.56. Receiver operating curve analysis for QFR and %DS with a FFR cut off value <0.80 showed an area under the curve of 0.97 and 0.77, respectively. The sensitivity, specificity and diagnostic accuracy of QFR were 87.5%, 95% and 92.8%, respectively. There was a discordance in four vessels (7.1%) between QFR and FFR. CONCLUSION QFR has a good diagnostic performance in comparison to the gold standard FFR for physiological assessment of intermediate lesions. Its performance is significantly better than the anatomical % DS (p < 0.001).
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Affiliation(s)
- Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudhanshu Budakoty
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Xu X, Fam JM, Low AFH, Tan RS, Chai P, Leng S, Allen J, Teo LL, Ong CC, Chan MYY, Huang T, Wong ASL, Wu Q, Lim ST, Zhong L. Sex differences in assessing stenosis severity between physician visual assessment and quantitative coronary angiography. Int J Cardiol 2021; 348:9-14. [PMID: 34864078 DOI: 10.1016/j.ijcard.2021.11.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Physician visual assessment (PVA) in invasive coronary angiography (ICA) is the current clinical method to determine stenosis severity and guide percutaneous coronary intervention. This study sought to evaluate the effect of sex differences in assessing coronary stenosis severity between PVA and quantitative coronary angiography (QCA). METHODS 209 patients with coronary artery disease (288 coronary lesions) underwent ICA and fractional flow reserve (FFR). ICA image processing including PVA and QCA was used to quantify diameter stenosis (DS). The difference of DS (ΔDS) between PVA and QCA was defined as DSPVA-DSQCA. DS ≥50% was considered anatomically obstructive. FFR ≤0.8 was defined as myocardial ischemia. RESULTS Mean ± SD age was 63 ± 9 years. There were no significant differences in DSPVA (61.1 ± 16.3% vs 60.1 ± 18.9%) and DSQCA (53.1 ± 12.1% vs 55.4 ± 14.3%) between females and males. However, ΔDS between PVA and QCA was higher in females (8.0 ± 10.9%) than in males (4.7 ± 10.9%) (P = 0.03). Thirty-four of 72 vessels (47.2%) in female patients and 75 of 216 vessels (34.7%) in male patients were classified differently by at least one grade using PVA compared to QCA assessment. DSPVA and DSQCA were negatively correlated with FFR in females (rPVA = -0.397, rQCA = -0.448) with an even stronger negative correlation in males (rPVA = -0.607, rQCA = -0.607). ROC analysis demonstrated that DSQCA had better discrimination capability for myocardial ischemia (FFR ≤ 0.80) than DSPVA in both sexes (P < 0.05). CONCLUSIONS A systematic bias was found in PVA (QCA reference) for overestimating severity of coronary artery disease in females compared to males.
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Affiliation(s)
- Xiuxiu Xu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jiang Ming Fam
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - Lynette Ls Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Ching Ching Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tieqiu Huang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Qinghua Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Soo Teik Lim
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
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Yang CD, Shen Y, Lu L, Yang ZK, Hu J, Zhang RY, Shen WF, Ding FH, Wang XQ. Visit-to-visit HbA 1c variability is associated with in-stent restenosis in patients with type 2 diabetes after percutaneous coronary intervention. Cardiovasc Diabetol 2020; 19:133. [PMID: 32887588 PMCID: PMC7472579 DOI: 10.1186/s12933-020-01111-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA1c variability is a potential predictor of ISR in diabetic patients after stent implantation. Methods We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA1c variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA1c variability for ISR. Results From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8 ± 1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA1c (P = 0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9 ± 16.8%, 0.42 ± 0.88 mm and 1.66 ± 0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of HbA1c (P < 0.001), and this trend was more prominent in patients with optimal glycemic control (HbA1c ≤ 7%) in the baseline. In multivariate analysis, HbA1c variability was independently associated with incidence of ISR after adjustment for traditional risk factors and mean HbA1c (HR: 3.00 [95% CI 1.14–7.92] for highest vs. lowest tertile). Inclusion of CV of HbA1c led to a better risk stratification accuracy. Assessing HbA1c variability by SD or VIM yielded similar findings. Conclusions This study suggests that visit-to-visit HbA1c variability is an independent predictor of incidence of ISR in patients with type 2 diabetes after stent implantation. Trial registration NCT02089360: NCT
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Affiliation(s)
- Chen Die Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China
| | - Ying Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhen Kun Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China
| | - Wei Feng Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, People's Republic of China.
| | - Feng Hua Ding
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China.
| | - Xiao Qun Wang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Road II, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Disease, Shanghai Jiao-Tong University School of Medicine, Shanghai, People's Republic of China.
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