TITLE:
Incremental value of preprocedural coronary computed tomographic angiography to classical coronary angiography for prediction of PCI complexity in left main stenosis
AUTHORS:
Imre Benedek, Monica Chitu, Istvan Kovacs, Bajka Balazs, Theodora Benedek
KEYWORDS:
Left Main; Syntax Score; Coronary Computed Tomographic Angiography
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.9,
December
23,
2013
ABSTRACT: Introduction:
The aim of our study was to assess the incremental value of Coronary Computed
Tomography Angiography (CCTA) added to classical coronary angiography, for
complex characterization of coronary lesions and prediction of procedural complexity
in patients with significant left main (LM) stenoses. Material and Methods:
Thirty-six patients with LM disease were enrolled in the study, and each
subject underwent CCTA followed by coronary angiography and percutaneous
revascularization. Results: Logistic regression analysis indicated a good
correlation between the angiographic-calculated and the CCTA-derived Syntax
scores for the whole group (r = 0.87, p 11.5 vs 25.2 +/-11.3, p = 0.01 for CCTA). In the same
time, Ca scoring was significantly higher and plaque volumes were significantly
larger in cases requiring complex revascularization procedures (299.5 +/-359.6
vs 917.3 +/-495.4, p = 0.04 for calcium score, 79.7 +/-28.5 vs 108.7 +/-25.3
mm3, p = 0.002 for plaque volumes). Multivariate analysis identified
the following CCTA parameters as significant predictors of increased risk for
complex intervention in LM lesions: plaque volume (OR 8.00, p = 0.008), Ca
scoring (OR 6.37, p = 0.02) and CCTA Syntax score (OR 6.87, p = 0.01). Conclusions:
CCTA derived parameters provide incremental information to
classical coronary angiography for preoperative assessment of lesion severity
in complex left main stenosis. CCTA derived Syntax score significantly correlates
with the classical Coronary Angiography Syntax score and identifies the
subgroup of patients who will be more exposed to procedural complications
during the revascularization interventions.