TCT-572 Coronary CT angiography for left main diameter assessment.

Abstract

Background: Coronary computed tomography angiography (CCTA) is emerging as a planning tool for percutaneous coronary intervention (PCI). However, information concerning the accuracy of vessel diameter for device selection is lacking. The left main coronary artery is a unique segment of the coronary circulation because of its size and minor movement during the cardiac cycle. This study aims to compare the accuracy of CCTA LM diameters compared with intravascular imaging (IVI) in the left main trunk. Method(s): This prospective multicenter study enrolled 98 patients undergoing PCIs for non-left main (LM) lesions who underwent both CCTA and IVI assessment (50 patients by intravascular ultrasound [IVUS] and 48 patients by optical coherence tomography [OCT]). The mean LM diameter derived from area was determined for each case at 3 levels: distal LM (immediately before the polygon of confluence), proximal LM (at the most proximal cross-section analyzable by IVI), and mid-LM in the middle of the 2 preceding measurements. These 3 cross-sections were matched between CCTA and IVI. Measurements were independently performed by 3 individual operators blinded to the results obtained from the alternative modality. The Bland-Altman and Passing-Bablok regression were used to assess the agreement between techniques. Result(s): The mean proximal, mid, and distal diameters assessed by CCTA were 4.2 +/- 0.6 mm, 4.0 +/- 0.7 mm, and 4.1 +/- 0.7 mm, respectively. Using IVI, the mean proximal, mid, and distal diameters were 4.4 +/- 0.6 mm, 4.4 +/- 0.6 mm, and 4.4 +/- 0.7 mm. Combining all cross-sections, the mean difference in LM diameter between CCTA and IVI was -0.35 mm (limits of agreement [LOA] -1.14 to 0.45). The results were similar between cases assessed with IVUS (mean difference -0.48 mm, LOA -1.35 to 0.39) and OCT (mean difference -0.21 mm, LOA -0.83 to 0.41). The Passing-Bablok regression analysis demonstrated no systematic or proportional differences (Coefficient A = 0.11; 95%CI: -0.23 to 0.43 and Coefficient B = 1.05; 95% CI: 0.97 to 1.13). Conclusion(s): Coronary CTA provides an accurate assessment of the LM diameters compared with IVI. Categories: IMAGING AND PHYSIOLOGY: Imaging: Intravascular.Copyright © 2024