Comparison of Optical Coherence Tomography-derived Minimal Lumen Area, Invasive Fractional Flow Reserve and FFRCT
- Conditions
- Coronary Stenosis
- Interventions
- Diagnostic Test: OCT, FFR, CTA and FFRCT
- Registration Number
- NCT03820492
- Lead Sponsor
- Insel Gruppe AG, University Hospital Bern
- Brief Summary
Significant left main (LM) stenosis is associated with a poor prognosis, therefore, adequate judgement of the prognostic significance of LM stenosis is essential to improve patients' prognosis. Recently, fractional flow reserve (FFR) has become widespread practice and carries a Class Ia recommendation to assess functional significance of intermediate coronary stenosis in patients with stable angina. Intravascular ultrasound (IVUS)-derived minimum lumen area (MLA) represents an accurate measure to determine LM significance as shown in multiple studies, while optical coherence tomography (OCT) ,which is a novel intracoronary imaging method with a greater spatial resolution (15μm vs. 100μm), faster image acquisition and facilitated image interpretation, OCT derived-MLA has never been validated against FFR and accordingly, it is not mentioned in the current guidelines for myocardial revascularization. Coronary computed tomography angiography (CTA) has emerged as a noninvasive alternative of coronary angiography with its excellent negative predictive value, while the positive predictive value of CTA is limited. Computational fluid dynamics is an emerging method that enables prediction of blood flow in coronary arteries and calculation of FFR from computed tomography (FFRCT) noninvasively. Noninvasive and accurate assessment of functional significance would bring a great benefit for patients with LM stenosis, however, there are no data to evaluate the diagnostic accuracy of FFRCT for LM stenosis in comparison with FFR and minimal lumen area derived by OCT.
This study will investigate the optimal OCT-derived MLA cut-off point and the diagnostic performance of FFRCT for intermediate LM stenosis compared with FFR ≤0.8 as a reference standard.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 104
- Unprotected LM lesion [midshaft, and distal bifurcation (Medina 1,1,1 or 1,1,0 or 1,0,1 or 1,0,0)] of 30% to 80% angiographic diameter stenosis (DS) on visual estimation or equivocal disease by angiography.
- Age ≥18 years.
- Ability to give preliminary oral consent witnessed by an independent physician or sign written informed consent prior to any study-specific procedures.
- Significant distal lesions (>50% angiographic DS on visual estimation within the left anterior descending artery [LAD] or left circumflex artery [LCX], except for ostium of LAD or LCX or diseased side branch [e.g. diagonal branch, obtuse marginal branch])
- Ostial LM disease.
- Acute coronary syndrome (ACS) (non-ST-elevation ACS and ST-elevation MI).
- LM In-stent restenosis.
- Previous coronary stenting of the left coronary system.
- Chronic total occlusion.
- Previous coronary artery bypass graft.
- Previous MI related to the left coronary artery.
- Occurrence of ventricularization or hypotension during engagement of the LM ostial lesion.
- The presence of hemodynamic instability.
- Known renal insufficiency (serum creatinine >1.5mg/dL or receiving dialysis).
- Female of childbearing potential (age <50 years and last menstruation within the last 12 months), who did not undergo tubal ligation, ovariectomy or hysterectomy.
- Life expectancy less than 1 year.
- Contraindication or known allergy against protocol-required medications including heparin, iodinated contrast, β-blocker, nitroglycerin, and adenosine.
- Body mass index >35kg/m2.
- Complex congenital heart disease other than anomalous coronary origins alone.
- Ventricular septal defect.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Patient with left-main stenosis OCT, FFR, CTA and FFRCT Multimodality assessment of intermediate left main stenosis: Comparison of optical coherence tomography-derived minimal lumen area, invasive fractional flow reserve and FFRCT
- Primary Outcome Measures
Name Time Method OCT vs. FFR Measurement at Procedure/ Baseline Visit -The optimal cut-off point of OCT-derived MLA from receiver-operator characteristics curves for FFR≤0.8
FFRCT vs. FFR Measurement at Procedure/ Baseline Visit Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FFRCT≤0.8 for FFR≤0.8
- Secondary Outcome Measures
Name Time Method OCT vs. FFR, RFR, resting Pd/Pa, FFRCT, QFR Measurement at Procedure/ Baseline Visit - The area under the curve and the optimal cut-off point of OCT-derived MLA from receiver-operator characteristics curves for FFR≤0.75, RFR≤0.89, resting Pd/Pa≤0.91, and FFRCT≤0.80 and QFR≤0.80
Clinical endpoint at 1 year 12 Month Acute renal failure
OCT vs. CTA Measurement at Procedure/ Baseline Visit - Diagnostic accuracy of plaque characteristics with presumed high risk characteristics including napkin ring sign, low attenuation plaque (\<30HU), positive remodelling (remodelling index \>1.1), and spotty calcium (\<3mm) for thin and thick cap fibroatheroma by OCT.
OCT vs. FFR, RFR, resting Pd/Pa, FFRCT Measurement at Procedure/ Baseline Visit - Correlation among OCT-derived MLA, FFR, RFR, resting Pd/Pa, and FFRCT and QFR
Trial Locations
- Locations (13)
Universitätsklinikum Giessen Justus-Liebig Universität
🇩🇪Gießen, Hesse, Germany
Inselspital
🇨🇭Bern, Switzerland
Gifu heart center
🇯🇵Gifu, Japan
Institute Mutualiste Montsouris
🇫🇷Paris, France
Ageo Central General Hospital
🇯🇵Ageo, Japan
Kansai Medical University,
🇯🇵Osaka, Japan
Medical Corporation Ouyuukai Tokorozawa Heart Center
🇯🇵Saitama, Japan
Centre Hospitalier Universitaire de Clermont-Ferrand
🇫🇷Clermont-Ferrand, France
Department of Cardiovascular Medicine Shinshu University School of Medicine
🇯🇵Nagano, Japan
Friedrich Alexander Universität (FAU) , Medizinische Klinik 2 , Kardiologie und Angiologie
🇩🇪Erlangen, Germany
Centre Cardiologique du Nord
🇫🇷Saint-Denis, France
Sapporo Higashi Tokushukai Hospital
🇯🇵Sapporo, Japan
CHUV
🇨🇭Lausanne, Switzerland