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Universitatea de Medicina si Farmacia Targu MuresSpitalul Judetean de Urgenta
Clinica de Cardiologie Prof. Dr. Benedek Imre, FESC
INCREMENTAL VALUE OF PREPROCEDURAL COORNARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY COMPLEXITY IN LEFT MAIN STENOSIS
BALAN DANIEL | MG, IV.
Coordinator : Prof. Dr. Benedek Imre,
Prof.Dr. Benedek Theodora,
Dr. Kovács István,
Co-authors: Diana Elena Opincariu , Ioan Sorin Pop,
Carmen Oana Moldovan
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Introduction Coronary angiography has become nowadays the gold standard
technique for diagnosis of coronary artery stenoses
A positive coronary angiography showing severe narrowing of the LM indicates an urgent need for revascularization
The SYNTAX trial (The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) revealed the role of percutaneous revascularization in several subsets of patients
Syntax trial led to development of the Syntax score complex angiographic score based on characterization of coronary lesions according to specific angiographic parameters -tortuosity, bifurcation, the presence of a total occlusion or intracoronary thrombus, calcification, the dominance, type and number of lesions
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Objectives
1) To prove the correlation between CCTA Syntax score and coronarography Syntax score in low-, medium- and high-risk patients.
2) Correlation between CCTA Calcium scoring and CCTA/coronarographyc Syntax score.
3)Recognise those CCTA and angiographyc derived markers which indicate the complexity of the percutan intervention in patients with left main stenosis.
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Material and methods
Thirty-six patients with LM disease at the clinical presentation were enrolled in the study, and each subject underwent 64 multi-slice CT followed by coronary angiography and percutaneous revascularization.
Based on the coronary Syntax score we distinguish
3 groups: high risk patients
medium risk patients
low risk patients
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Material and methods
Coronarography
Parameters: coronary dominance,
number and location of lesions, presence of a total occlusion in one coronary
artery,
bifurcation,
presence of calcification or thrombus
Coronary Computed Tomographic Angiography
Parameters: degree of calcification in the left main lesion ,
calcium score,
coronary stenosis severity,
length and diameter of the left main,
dominance,
plaque volume.
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Characteristic Values(%)
Age ,years 62,9 +/- 9.5 95% CI 59.7 -69.2Gender, male 29(67.4)Left Ventricular Ejection Fraction 49.2 +/-7.2 95% CI 46.7 – 51.7Cardiovascular risk factors
Hypertension 21 (58.3)Hyperlipidemia 15 (41.6)Diabetes 12 (33.3)Smoker 13 (36.1)Obesity(BMS>25 km/m2) 11 (30.5)
CCTA analysisCalcium scoring 784.9+/-77.6
95% CI 627.1 – 942.7LM plaque burden 224.3 +/-45.0
95% CI 132.8 – 315.8
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We found a good correlation between the calcium score determined by CCTA and the Syntax scores, either as determined by Coronary Angiography (r=0.72, p<0.0001)
Results
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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ResultsAngiographic| Syntax CCTA | Syntax p value
Global population 0,4
Mean+/- SD 29,1 +/- 13,9 31,6 +/- 12,6
95% conf. Int. 24,4 – 33,8 27,3 – 35,9
Low risk group 0,03
Mean+/- SD 13,0 +/- 4,8 18,9 +/- 7,6
95% conf. Int. 9,9 – 16,1 14,1 – 23,7
Medium risk group 0,4
Mean+/- SD 28,2 +/- 4,1 30,7 +/- 8,1
95% conf. Int. 25,1 – 31,4 24,6 – 37,0
High risk group 0,8
Mean+/- SD 42,4 +/- 5,9 43 +/- 8,2
95% conf. Int. 39,2 – 45,7 38,5 – 47,5Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results In the low risk group the angiographic
coronarography seems to underestimate the severity of the lesion as compared to CCTA.
(Angio Syntax : 13,0 +/- 4,8 | CCTA Syntax 18.9 +/- 7.6)
p=0.03
angio Syntax CCTA Syntax0.00
5.00
10.00
15.00
20.00
13,00
18.90
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ResultsNo statistically significant difference in the medium and high risk groups.
p=0.4 p=0.8
Angiográfia | Syn-tax
CCTA | Syntax26.5027.0027.5028.0028.5029.0029.5030.0030.5031.00
28.2
30.7
Angiográfia | Syn-tax
CCTA | Syntax42.00
42.20
42.40
42.60
42.80
43.00
43.20
42.4
43
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ResultsNon komplex PCI Komplex PCI p value
LM plaque volume 0,002
Mean+/- SD 79,7 +/- 28,5 108,7 +/- 25,3
95% conf. Int. 63,9 – 95,5 97,2 – 120,2
Angio Syntax score 0,09
Mean+/- SD 24,5 +/- 11,5 32,3 +/- 14,6
95% conf. Int. 18,1 – 30,9 25,7 – 38,9
CCTA Syntax score 0,01
Mean+/- SD 25,2 +/- 11,3 35,3 +/- 11,5
95% conf. Int. 18,9 – 31,5 30,1 – 40,5
Ca scoring 0,04
Mean+/- SD 599,5 +/- 359,6 917,3 +/- 495,4
95% conf. Int. 400,4 – 798,7 691 – 1142,8
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results Identification of complexity predictors (PCI)
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Results
Important LM stenosis with high Ca level and big volume plaque
(A) – 3D CCTA
(B) – multiplanar reconstruction
(C) – coronarography before PCI ...
(D) – ... and after.
The conventional angiography underestimates the severity of the lesion compared to the CCTA
Benedek I.,World Jurnal of Cardiovascular Diseases, 2013
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Conclusion
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
Based on these findings, CCTA could represent a new noninvasive clinical tool, useful for preoperative evaluation of patient risk and for selection of the best therapeutic strategy in these cases.
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Personal contribution
Patient data collection and interpretation
Participation at the calculation of Angiographic and CCTA Syntax Score
Familiarization with the advantages and the indications of invasive and non-invasive imaging solutions
PowerPoint presentation
The attendance at related courses and workshops with the members of Cardiology Scientific Group.
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Thank you for your attention!