title: Computed tomography angiography versus angiography for guiding percutaneous coronary interventions in bifurcation lesions - A prospective randomized pilot study.
abstract: BACKGROUND
  There is no data on the impact of coronary computed tomography angiography (coronary CTA), as an addition to angiography, on the outcomes of percutaneous coronary interventions (PCI) in bifurcation lesions.
  
  
  METHODS
  Patients with stable coronary artery disease scheduled for elective bifurcation PCI were randomized 1:1 to planning the procedure based on coronary CTA and angiography (CTA group) or angiography alone (CA group). The primary efficacy endpoint was the immediate angiographic result. Secondary efficacy endpoints were: a) procedural characteristics and b) postprocedural fractional flow reserve (FFR) in the side branch (SB) in a subgroup of patients. Safety outcomes were: a) periprocedural myocardial infarction, b) contrast use and c) radiation dose.
  
  
  RESULTS
  PCI of 45 lesions in the CTA group and 47 lesions in the CA group was performed. Postprocedural lumen diameters in the main branch (MB) and SB, frequency of SB compromise or occlusion and mean SB FFR values were not different between study groups. Two or more stents were implanted less frequently in the CTA group than in the CA group (18% vs. 43%, p = 0.01). This difference was driven by less frequent MB 2-stent overlap in the CTA group (7 vs. 21%, p = 0.046) and numerically less SB stenting (11% vs. 21%, p = 0.07). Proximal optimization technique was used more frequently in the CTA group (44% vs. 21%, p = 0.018).
  
  
  CONCLUSIONS
  CTA-assisted bifurcation PCI leads to similar immediate results compared with angiography alone, however is associated with higher use of single-stent procedures with proximal optimization, less frequent 2-stent overlap and less SB stenting.
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland. Electronic address: rwolny@ikard.pl.
authors.forename: Rafal
authors.initials: R
authors.lastname: Wolny
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.affiliation: Department of Coronary and Structural Heart Disease, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.affiliation: Department of Coronary and Structural Heart Disease, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, New York, 10019 NY, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: University Heart Center Graz, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Toth
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Debski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Ciszewski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kukula
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D010865:Pilot Projects; D011044:Poland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure; D016037:Single-Blind Method; D015607:Stents; D016896:Treatment Outcome
keywords: Bifurcations; Coronary CTA; Percutaneous coronary intervention; Planning; Side branch