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Side branch occlusion is one of the major technical hurdles in the percutaneous coronary intervention of bifurcation lesion. We investigated whether preprocedural coronary computed tomography angiography could predict intraprocedural SB occlusion.
A total of 260 bifurcation lesions were enrolled from 246 patients who underwent CCTA before elective PCI for bifurcation lesion. Quantitative plaque analysis was done in both main vessel (MV) and SB. SB occlusion was defined by loss of anterograde flow with thrombolysis in myocardial infarction flow grade 0 or 1 immediately after ballooning or stent implantation.
Intraprocedural SB occlusion occurred in 42 lesions (16%). These lesions could be characterized by SB plaque length 35mm, calcified plaque in the MV, low attenuation plaque in main proximal segment or side branch, and the ratio of MV to SB ostium area > 4.3, which constituted point-based CT bifurcation score. CT bifurcation score was cross-validated and outperformed (c-statistics = 0.751) any angiographic Medina classifications or angiographic RESOLVE score (c-statistics = 0.631 to 0.551; P < 0.05, all). The risk of SB occlusion proportionally increased from 5% to 64% according to CT bifurcation score of 0 to 3. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT bifurcation score ≥1 was 86%, 54%, 26%, 95%, and 59%, respectively.
Comprehensive CCTA assessment could predict intraprocedural side branch occlusion better than current angiographic classification or scoring system. CT bifurcation score might be helpful for the guidance of optimal PCI strategy for bifurcation lesion.
IMAGING: Imaging: Non-Invasive