Validity and variability in visual assessment of stenosis severity in phantom bifurcation lesions: A survey in experts during the fifth meeting of the european bifurcation club

Girasis, Chrysafios; Onuma, Yoshinobu; Schuurbiers, Johan C.H.; Morel, Marie‐Angèle; Es, Gerrit‐Anne van; Geuns, Robert‐Jan van; Wentzel, Jolanda J.; Serruys, Patrick W.

doi:10.1002/ccd.23213

Cited by 34 publications

(20 citation statements)

References 68 publications

(49 reference statements)

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“…The comparison of findings from different bifurcation stent studies is hampered by the fact that there is no uniformity in the minimum size of (relevant) side-branches and no general consent on whether to determine side-branch size visually or per QCA [4, 10, 13, 14, 25, 40]. Bifurcation lesions with side-branches ≥2 mm, as addressed in our present study, were also examined in the Z-SEAside and the SEAside studies [9, 25].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

et al. 2016

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The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

et al. 2016

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“…47 Although standard 2D QCA is well recognized to be superior to visual assess ment (that is, nonquantitative plain angiography) in determining the severity of coronary steno ses, 48-50 the limitations of spatial and temporal resolution, vessel tortuosity, and lesion asymmetry persist even in QCA. 50 As a result, QCA find ings correlate only modestly with FFR. 51 In a study that compared the perfor mance of visual angiographic assessment, standard QCA, and FFR in assessment of intermediateseverity stenoses (40-70%), QCA findings could not predict an FFR of <0.75 in patients with lesions of ≥60% steno sis or with a minimum luminal dia meter≥1.4 mm.…”

Section: Perspectives Visual-functional Mismatchmentioning

confidence: 97%

Revascularization in multivessel CAD: a functional approach

Shannon

Colombo

2012

Nat Rev Cardiol

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The primary objective of invasive treatment strategies for multivessel coronary artery disease is complete anatomical revascularization--traditionally considered the strongest predictor of improved clinical outcome in this setting. This concept, however, is being challenged by evidence suggesting that addressing ischemia is the key to reducing mortality, myocardial infarction, and life-limiting angina. As objective evidence of ischemia can be provided by a functional assessment on the basis of fractional flow reserve, the focus of contemporary treatment should arguably shift from anatomical to functional revascularization. Moreover, the decision to revascularize specific lesions should be made after consideration of the degree of myocardial viability, ischemic burden, overall clinical risk, and technical feasibility. Most importantly, however, the revascularization strategy should be tailored to the individual patient and the expertise of the institution, and use contemporary techniques combined with modern pharmacotherapy. This Perspectives article summarizes the data supporting contemporary functional revascularization and its applicability to real-world practice.

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“…Every individual bifurcation had a lesion, wherein at least one vessel segment had a DS of >60% with the MLD being located within 3-6 mm from the point of bifurcation. The range of diameters, lesion length, angulation, and Medina class [5] used in the design of these 18 bifurcations reflected the anatomic variation and the fractal nature of bifurcations in the human coronary tree as derived from relevant literature [6,7,11,12].…”

Section: Phantom Modelsmentioning

confidence: 99%

In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting

Ishibashi

Grundeken

Nakatani

et al. 2014

Cathet Cardio Intervent

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Validity and variability in visual assessment of stenosis severity in phantom bifurcation lesions: A survey in experts during the fifth meeting of the european bifurcation club

Abstract: Visual assessment by experts is more variable and less precise in the analysis of bifurcation lesions compared to bifurcation QCA software.

Cited by 34 publications

References 68 publications

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

Revascularization in multivessel CAD: a functional approach

In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting

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