Author + information
- Arzu Kalayci1,
- Ecem Akdogan2,
- Can Karabay3,
- Ibrahim Tanboga4,
- Abdurrahman Naser2,
- Ozkan Candan1,
- Cetin Gecmen5,
- Ender Ozgun Cakmak2,
- Muslum Sahin2,
- Ibrahim Akin Izgi6,
- Mehmet Muhsin Turkmen7 and
- Cevat Kirma8
- 1Kosuyolu Heart and Research Hospital, Istanbul, Turkey
- 2Kosuyolu Heart Hospital, Istanbul, Turkey
- 3Dr. Siyami Ersek EAH, Istanbul, Turkey
- 4univ, erzurum, Turkey
- 5koşuyolu, istanbul, Turkey
- 6Kosuyolu Yuksek Ihtisas Hastanesi, Kartal, Turkey
- 7Kartal Kosuyolu Yuksek Ihtisas EAH, Istanbul, Turkey
- 8Kartal koşuyolu heart research and tarihini hospital, Istanbul, Turkey
Aim: Previous studies have shown a poor correlation between angiographic assessment of stenosis grade (%) and its functional assessment by fractional flow reserve (FFR). Recently, two scoring systems (DILEMMA and P20DAC2) have been published in the literature which combine some angiographic parameters provided better prediction of significantly reduced FFR (≤0.8). This study aimed to analyse and compare the diagnostic accuracy of DILEMMA score and P20DAC2 score in prediction of functional significance of LAD (left anterior descending) intermediate lesions.
A hundred and fourteen patients with intermediate LAD stenoses (30-70%) were prospectively and consecutively enrolled. We calculated and compared the two scoring systems in prediction of functionally significance of intermediate LAD lesions.
A total of 114 patients with intermediate LAD lesions (age 59.9 ± 9.2 years, 81.6 % male) were included. Coronary angiograms were prospectively analysed by using DILEMMA and P20DAC2 scores and matched with FFR values. Adenosine was used intracoronary (i.c.) for all patients. FFR values of 0.80 or less were considered as ischemia-causing lesions. The baseline and post adenosine Pd/Pa ratio was calculated (0.88 ± 0.06, 0.81 ± 0.06, respectively). 43.9% of the lesions were significant according to 0.80 cut-off value. The diagnostic accuracy of the two scoring systems in prediction of functionally significance was analysed by using comperative ROC (receiver operator characteristic) curve method. The area under the ROC curves of P20DAC2 score was better than DILEMMA score (AUC: 0.824, 95% CI [0.747-0.900], p< 0.001, AUC:0.609, 95% CI [0.503-0.715], p=0.047 respectively) (figure 1,2). The AUC (area under curve) based diagnostic performance of P20DAC2 score was significantly higher than DILEMMA score (p<0.001). Inter- and intra-observer agreement of P20DAC2 score was significantly better compared to DILEMMA score. In addition, while there was a weak negative correlation between DILEMMA score and FFR values (r=-0.183, p=0.051), there was a statistically significant negative correlation between P20DAC2 score and FFR values (r=-0.514, p<0.001) (figure 4a, 4b).
Our results indicate that P20DAC2 score has higher diagnostic performance than DILEMMA score in prediction of hemodynamically significant LAD lesions.
CORONARY: Angiography and QCA