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| Name | Class |
|---|---|
| Seoul National University Hospital | OTHER |
| Naju National Hospital | OTHER |
| Chonnam National University Hospital | OTHER |
| Samsung Medical Center |
This study was performed to investigate the anatomical attributes that determine myocardial territory of diagonal branches and to develop a prediction model for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA).
Bifurcation lesion is one of the most challenging lesion subsets in the field of percutaneous coronary intervention (PCI). Despite the recent advances in PCI techniques and stent technology, most randomized studies failed to prove the superiority of systematic 2 stenting strategy compared with provisional side branch intervention strategy.
A certain amount of ischemic burden is required to achieve the benefit of revascularization over medical treatment. Compared with major epicardial vessels, side branches are smaller, more variable in anatomy, supplying less myocardium and less clinically relevant. Therefore, it is important to assess the myocardial mass at risk of side branches to determine the appropriate treatment strategy for bifurcation lesions. However, how to define the clinically relevant side branches which can be associated with the benefit of revascularization in a cardiac catheterization laboratory is not well-known.
The investigators performed this study to investigate the anatomical attributes that determine ischemic burden and myocardial territory of diagonal branches and to develop a prediction model for a clinically relevant diagonal branch using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MPI arm | For the MPI arm, patients with severe jailed diagonal branch disease with available MPI in 3 months were selected from the Seoul National University Hospital Cardiac Catheterization and MPI database. | ||
| CCTA arm | For the CCTA arm, patients from a previous multicenter prospective CCTA registry were retrospectively reviewed for a post-hoc analysis. |
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| Measure | Description | Time Frame |
|---|---|---|
| Angiographic attributes for diagonal branches | Angiographic attributes for diagonal branches were visually defined as follows :
| through study completion, an average of 1year |
| Sensitivity of prediction model | Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. | through study completion, an average of 1year |
| Specificity of prediction model | Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. | through study completion, an average of 1year |
| Negative predictive value of prediction model | Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. | through study completion, an average of 1year |
| Positive predictive value of prediction model | Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. | through study completion, an average of 1year |
| Area under the curve of prediction model |
| Measure | Description | Time Frame |
|---|---|---|
| %Ischemia | Myocardium of perfusion image was divided into 20 segments, and summed rest score (SRS), summed stress score (SSS), and summed difference score (SDS) were scored in each segment according to a 5-grade system (0-4) for the assessment of perfusion status. (1) SSS and SDS of diagonal segments were converted to percent of myocardial ischemia (%ischemia) of diagonal territory by dividing summed scores by 80 and multiplying by 100. |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with angina pectoris
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| Name | Affiliation | Role |
|---|---|---|
| Bon-Kwon Koo, MD, PhD | Seoul National University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11337562 | Background | Paeng JC, Lee DS, Cheon GJ, Lee MM, Chung JK, Lee MC. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated 99mTc-sestamibi myocardial SPECT. J Nucl Med. 2001 May;42(5):695-700. | |
| 27423225 | Background | Kim HY, Lim HS, Doh JH, Nam CW, Shin ES, Koo BK, Yoon MH, Tahk SJ, Kang DK, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Kim EK, Kim SM, Choe Y, Choi JH. Physiological Severity of Coronary Artery Stenosis Depends on the Amount of Myocardial Mass Subtended by the Coronary Artery. JACC Cardiovasc Interv. 2016 Aug 8;9(15):1548-60. doi: 10.1016/j.jcin.2016.04.008. Epub 2016 Jul 13. |
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| ID | Term |
|---|---|
| D060050 | Angina, Stable |
| D000789 | Angina, Unstable |
| D007511 | Ischemia |
| ID | Term |
|---|---|
| D000787 | Angina Pectoris |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| OTHER |
| Ewha Womans University | OTHER |
| Ajou University School of Medicine | OTHER |
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Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. |
| through study completion, an average of 1year |
| Accuracy of prediction model | Prediction model using anatomical attributes to define clinical relevance of diagonal branches will be developed. | through study completion, an average of 1year |
| through study completion, an average of 1year |
| %FMM | FMM was calculated using stem-and-crown model as described in the parent study. (2) FMM of each diagonal brach was converted to percent FMM (%FMM) of diagonal branch by dividing each FMM by left ventricular myocardial mass. | through study completion, an average of 1year |
| 31719001 | Derived | Jeon WK, Park J, Koo BK, Suh M, Yang S, Kim HY, Lee JM, Kim KJ, Choi JH, Lim HS, Paeng JC, Hwang D, Kim HS; Collaborators. Anatomical attributes of clinically relevant diagonal branches in patients with left anterior descending coronary artery bifurcation lesions. EuroIntervention. 2020 Oct 9;16(9):e715-e723. doi: 10.4244/EIJ-D-19-00534. |
| D014652 |
| Vascular Diseases |
| D002637 | Chest Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |