title: Three-dimensional quantitative coronary angiography and quantification of jeopardised myocardium to predict functional significance of intermediate coronary artery stenosis.
abstract: OBJECTIVE
  Despite the fact that fractional flow reserve (FFR) is better than angiography in guiding PCI, in the real world the choice to perform PCI is generally based on angiography. Three-dimensional quantitative coronary angiography (3D-QCA) may increase the accuracy of angiography, especially in intermediate coronary artery stenosis (ICAS). The aim of the study was to assess the best cut-off values of area stenosis % (AS%) and the extent of jeopardised myocardium for predicting FFR and for excluding the need to perform FFR.
  
  
  RESULTS
  FFR, AS% and Myocardial Jeopardy Index (MJI) were assessed in 211 ICAS. MJI (=-0.36; p=0.001), AS% (=-0.35; p=0.001) and presence of a chronic total occlusion (CTO) (=-0.15; p=0.01) were independent predictors of FFR. In patients without CTO (174 lesions), the best cut-offs for the detection of FFR ≤0.80 for AS% and MJI were 61% (AUC=0.76; p<0.001) and 30% (AUC=0.71; p<0.001), respectively. More importantly, the cut-offs of AS% safely to exclude (100% sensitivity) an FFR ≤0.80 were 40% (AUC=0.85, p<0.001) for an MJI ≥30% and 50% (AUC=0.70, p<0.04) for an MJI <30%, respectively.
  
  
  CONCLUSIONS
  AS%, MJI and the presence of a CTO predicted FFR values. 3D-QCA in addition to MJI allows the safe exclusion of FFR ≤0.80, limiting FFR assessment to doubtful cases with considerable reduction of costs.
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Alberto Ranieri
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Giovanni Luigi
authors.initials: GL
authors.lastname: De Maria
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.forename: Francesco
authors.initials: F
authors.lastname: Tagliaferro
authors.forename: Andrea
authors.initials: A
authors.lastname: Gardi
authors.forename: Fabio
authors.initials: F
authors.lastname: Clemente
authors.forename: Domenico
authors.initials: D
authors.lastname: Laezza
authors.forename: Eloisa
authors.initials: E
authors.lastname: Basile
authors.forename: Pio
authors.initials: P
authors.lastname: Cialdella
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Adrian Paul
authors.initials: AP
authors.lastname: Banning
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index