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.
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Luigi
authors: L
authors: Biasco
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Frants
authors: F
authors: Pedersen
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Jacob
authors: J
authors: Lønborg
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Lene
authors: L
authors: Holmvang
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Steffen
authors: S
authors: Helqvist
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Kari
authors: K
authors: Saunamäki
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Henning
authors: H
authors: Kelbaek
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Peter
authors: P
authors: Clemmensen
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Göran K
authors: GK
authors: Olivecrona
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Erik
authors: E
authors: Jørgensen
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark.
authors: Thomas
authors: T
authors: Engstrøm
authors: The Heart Centre, Rigshospitalet, Copenhagen, Denmark. Electronic address: ole.debacker@gmail.com.
authors: Ole
authors: O
authors: De Backer
mesh_terms: D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index