Introduction Unlike invasive coronary angiography (ICA) which allows visualisation of the coronary vessel lumen, coronary CT angiogram (CCTA) allows both visualisation of the vessel lumen and the vessel wall. The information obtained may potentially allow better pre-PCI planning and safe outcomes.
Aim The aim of this prospective study was to assess the efficacy and safety of CT guided PCI in patients with left main and or triple vessel coronary disease.
Methods Patients, who were listed for PCI based on the results of CCTA, were randomly selected in the study over a 5 year period. Coronary CT angiographic inclusion criteria were, 50%–100% dm occlusion in a major coronary artery with a target vessel diameter ≥2.25 mm, involving all 3 of the main coronary arteries and or left main coronary artery. They underwent CCTA using 64 MSCT and 128 MSCT scans. Coronary stenoses on the ICA were determined independently in the catheterisation laboratory using online quantification software. Coronary angiographic inclusion criteria were 50%–100% diameter occlusion, and vessel diameter ≥2.25 mm.
Results A total of 34 consecutive patients who met the inclusion criteria were enrolled during the study period. The mean age was 57.2±8.2 years while the male to female ratio was 15:2. There were 544 coronary segments in the study population. There were 177 (32.5%) coronary segments with significant (≥50%) stenosis on CCTA. In comparison, there were 180 coronary segments with significant stenosis on ICA. The difference is accounted for by 6 false negative and 3 false positive results on CCTA. All patients who were scheduled for PCI on the basis of the CCTA results proceeded to PCI. A total of 116 stents were implanted, representing an average of 3.4±1.6 stents per patient (range, 1–12 stents). Technical success was achieved in all the 34 patients who proceeded to PCI. Significant triple vessel disease was present in 88.2% (30/34) of patients and left main disease was present in 11.8% (4/34). During PCI and stenting, there were no patients who had a major adverse cardiac event (MACE), developed a stroke, underwent emergency bypass graft surgery or died. During follow-up (mean of 24 months) only 1 patient had another PCI done due to development of significant lesion in the non-stented segment after approximately 38 months from the previous CT scan and PCI. The 5-year event-free survival was 100%.
Conclusion All eligible patients who underwent pre-PCI CT planning were associated with uncomplicated and successful procedures. The long-term outcome was excellent as there were no repeat procedures due to restenosis and no emergency CABG was needed.
- Coronary CT
- left main coronary disease