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Journal Club 9 May 2012

Article

Morphometric Assessment of Coronary Stenosis Relevance With Optical Coherence Tomography
A Comparison With Fractional Flow Reserve and Intravascular Ultrasound

Presenter

MD

PICO

This paper compared optical coherence tomography and intravascular ultrasound anatomical measurements correlation with functional significance of intermediate coronary stenosis as assessed using fractional flow reserve

Population

Patients scheduled for coronary angiography in whom 1 or more coronary stenoses with intermediate angiographic severity (40% to 70% diameter stenosis by quantitative coronary angiography [QCA])

Exclusions: Stenoses located in culprit vessels of acute coronary syndromes, serial stenoses, or diffuse coronary narrowings were excluded. Vessels providing circulation to previously infarct regions were also excluded. Other exclusion criteria were left main stenosis,
graft stenosis, contraindications to adenosine administration, hemodynamic instability, renal insufficiency, and anatomical
characteristics such as vessel tortuosity and severe calcification that do not allow the advancement of OCT and IVUS catheters.

Intervention

Optical coherence tomography: minimal luminal area, minimal luminal diameter, area stenosis

Comparator

Intravascular ultrasound: minimal luminal area, minimal luminal diameter, area stenosis

Outcome

Correlation between the measures and FFR were determined.  Receiver operator characteristic curves were created and limits of agreement of the anatomical measures between IVUS and OCT were determined.

Findings

Angiographic stenosis severity was 50.9  8% diameter stenosis with 1.28  0.3 mm minimal lumen diameter.
FFR was 0.80 in 28 (45.9%) stenoses. An overall moderate diagnostic efficiency of OCT was found (area under
the curve [AUC]: 0.74; 95% confidence interval [CI]: 0.61 to 0.84), with sensitivity/specificity of 82%/63% associated
with an optimal cutoff value of 1.95 mm2. Comparison of the results in patients with simultaneous IVUS
and OCT imaging revealed no significant differences in the diagnostic efficiency of OCT (AUC: 0.70; 95% CI: 0.55
to 0.83) and IVUS (AUC. 0.63; 95% CI: 0.47 to 0.77; p  0.19). Sensitivity/specificity for IVUS was 67%/65% for
an optimal cutoff value of 2.36 mm2. In the subgroup of small vessels (reference diameter 3 mm) OCT
showed a significantly better diagnostic efficiency (AUC: 0.77; 95% CI: 0.60 to 0.89) than IVUS (AUC: 0.63; 95%
CI: 0.46 to 0.78) to identify functionally significant stenoses (p  0.04).

See also this post for further material.

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Coronary stenosis measurement

March 19, 2012 3 comments