Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve

Luigi Biasco; Frants Pedersen; Jacob Lønborg; Lene Holmvang; Steffen Helqvist; Kari Saunamäki; Henning Kelbæk; Peter Clemmensen; Göran K Olivecrona; Erik Jørgensen; Thomas Engstrøm; Ole De Backer

doi:10.1016/j.amjcard.2015.02.047

Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve

Luigi Biasco, Frants Pedersen, Jacob Lønborg, Lene Holmvang, Steffen Helqvist, Kari Saunamäki, Henning Kelbæk, Peter Clemmensen, Göran K Olivecrona, Erik Jørgensen, Thomas Engstrøm, Ole De Backer

Department of Clinical Medicine

11 Citations (Scopus)

Abstract

Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50.8% [42.5-65.0%] for the left main (LM), 62.2% [50.0-72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5-77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0-80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5-82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30-50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) "apical wrap" of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram-in which besides stenosis grade also other lesion/vessel characteristics are evaluated-can lead to a more accurate identification of functionally significant coronary stenoses.

Original language	English
Journal	American Journal of Cardiology
Volume	115
Issue number	11
Pages (from-to)	1475-80
Number of pages	6
ISSN	0002-9149
DOIs	https://doi.org/10.1016/j.amjcard.2015.02.047
Publication status	Published - 1 Jun 2015

Keywords

Coronary Angiography
Coronary Stenosis
Female
Fractional Flow Reserve, Myocardial
Humans
Male
Middle Aged
Retrospective Studies
Severity of Illness Index

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10.1016/j.amjcard.2015.02.047

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Biasco, L., Pedersen, F., Lønborg, J., Holmvang, L., Helqvist, S., Saunamäki, K., Kelbæk, H., Clemmensen, P., Olivecrona, G. K., Jørgensen, E., Engstrøm, T., & De Backer, O. (2015). Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve. American Journal of Cardiology, 115(11), 1475-80. https://doi.org/10.1016/j.amjcard.2015.02.047

Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve. / Biasco, Luigi; Pedersen, Frants; Lønborg, Jacob et al.
In: American Journal of Cardiology, Vol. 115, No. 11, 01.06.2015, p. 1475-80.

Research output: Contribution to journal › Journal article › Research › peer-review

Biasco, L, Pedersen, F, Lønborg, J, Holmvang, L, Helqvist, S, Saunamäki, K, Kelbæk, H, Clemmensen, P, Olivecrona, GK, Jørgensen, E, Engstrøm, T & De Backer, O 2015, 'Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve', American Journal of Cardiology, vol. 115, no. 11, pp. 1475-80. https://doi.org/10.1016/j.amjcard.2015.02.047

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title = "Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve",

abstract = "Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50.8% [42.5-65.0%] for the left main (LM), 62.2% [50.0-72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5-77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0-80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5-82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30-50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) {"}apical wrap{"} of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram-in which besides stenosis grade also other lesion/vessel characteristics are evaluated-can lead to a more accurate identification of functionally significant coronary stenoses.",

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T1 - Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve

AU - Biasco, Luigi

AU - Pedersen, Frants

AU - Lønborg, Jacob

AU - Holmvang, Lene

AU - Helqvist, Steffen

AU - Saunamäki, Kari

AU - Kelbæk, Henning

AU - Clemmensen, Peter

AU - Olivecrona, Göran K

AU - Jørgensen, Erik

AU - Engstrøm, Thomas

AU - De Backer, Ole

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50.8% [42.5-65.0%] for the left main (LM), 62.2% [50.0-72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5-77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0-80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5-82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30-50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) "apical wrap" of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram-in which besides stenosis grade also other lesion/vessel characteristics are evaluated-can lead to a more accurate identification of functionally significant coronary stenoses.

AB - Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). This study aimed to investigate whether a more comprehensive evaluation of the coronary angiogram may contribute to a better identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50.8% [42.5-65.0%] for the left main (LM), 62.2% [50.0-72.5%] for the proximal (prox)/mid left anterior descending (LAD) artery, 66.3% [57.5-77.5%] for the prox/mid right coronary artery (RCA), 70.5% [60.0-80.0%] for the prox left circumflex/first obtuse marginal (LCX/OM1), and 71.4% [62.5-82.5%] for the more distal segments. In patients with intermediate LAD lesions, 5 angiographic parameters were identified as independent predictors of flow limitation: (1) a 30-50% lesion prox to the lesion of interest, (2) lesion length >20 mm, (3) distal take-off of all diagonal branches ≥2 mm diameter, (4) "apical wrap" of LAD, and (5) collaterals to an occluded LCX/RCA. Based on these results, a risk score (P20-DAC2) for prediction of flow limitation in intermediate LAD lesions was derived. In conclusion, a comprehensive evaluation of the coronary angiogram-in which besides stenosis grade also other lesion/vessel characteristics are evaluated-can lead to a more accurate identification of functionally significant coronary stenoses.

KW - Coronary Angiography

KW - Coronary Stenosis

KW - Female

KW - Fractional Flow Reserve, Myocardial

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Severity of Illness Index

U2 - 10.1016/j.amjcard.2015.02.047

DO - 10.1016/j.amjcard.2015.02.047

M3 - Journal article

C2 - 25857401

SN - 0002-9149

VL - 115

SP - 1475

EP - 1480

JO - American Journal of Cardiology

JF - American Journal of Cardiology

IS - 11

ER -

Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve

Abstract

Keywords

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