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European Heart Journal Advance Access originally published online on July 9, 2007
European Heart Journal 2007 28(16):1968-1976; doi:10.1093/eurheartj/ehm195
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography

Carlos A.G. Van Mieghem1,2, Attila Thury1, Willem B. Meijboom1,2, Filippo Cademartiri1,2, Nico R. Mollet1,2, Annick C. Weustink1,2, Georgios Sianos1, Peter P.T. de Jaegere1, Patrick W. Serruys1 and Pim de Feyter1,2,*

1 Department of Cardiology, Thoraxcenter, Erasmus MC, Ba 589, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
2 Department of Radiology, Erasmus MC, Rotterdam, The Netherlands

Received 21 October 2006; revised 20 March 2007; accepted 13 April 2007; online publish-ahead-of-print 9 July 2007.

* Corresponding author. Tel: +31 10 4635071; fax: +31 10 4632686. E-mail address: p.j.defeyter{at}erasmusmc.nl

Aims: To compare the performance of 64-slice computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) in the detection and classification (according to the Medina system) of bifurcation lesions (BLs).

Methods and results: We studied 323 consecutive patients undergoing 64-slice CTCA prior to ICA. All coronary segments ≥2 mm in diameter were evaluated for the presence of a significant (≥50% diameter reduction on quantitative coronary angiography) BL. Evaluation of BL by CTCA included the assessment of significant lumen obstruction in both main and side branch vessels. Forty-one out of 43 patients (46/48 lesions) with significant BL were identified by CTCA. Excluding coronary segments with non-diagnostic image quality (5%), the sensitivity, specificity, and positive and negative predictive values of CTCA for detecting significant BL were 96, 99, and 85 and 99%, respectively. In 39 of these 41 patients, CTCA assessment was concordant with the Medina lesion classification on ICA.

Conclusion: Sixty-four-slice CTCA allows accurate assessment of complex BL.

Key Words: Bifurcations • Coronary atherosclerosis • Computed tomography coronary angiography • Percutaneous coronary intervention


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