Atherosclerosis, Coronary
Conditions
Keywords
Optical coherence tomography, Percutaneous coronary interventions, Coronary atherosclerosis in bifurcations
Brief summary
Investigator-initiated, international, multicentre, observational study with two cohorts. The two study cohorts will be: Cohort A: to understand if the local blood flow patterns (associated with low WSS), as evaluated by computational fluid dynamic tools from combined angiographic and OCT invasive images, may better predict the clinical outcome of patients with bifurcated coronary lesions treated by PCI. Cohort B: to understand if the local blood flow patterns (associated with low WSS), as evaluated by computational fluid dynamic tools from combined angiographic and OCT invasive images, may better predict the clinical outcome of patients with sub-critical bifurcated lesions managed conservatively. Coronary angiography and OCT images will be combined to obtain a three-dimensional model of the diseased coronary vessels that will be used to calculate the local blood flow patterns and the time-averaged WSS at the bifurcated lesion level by using computational fluid dynamics software. Baseline (in patients both managed conservatively and treated by PCI) and post-PCI (in patients treated by PCI) images will be processed.
Interventions
PROCEDURECoronary angiography and optical coherence tomography
Coronary angiography and OCT images will be combined to obtain a three-dimensional model of the diseased coronary vessels that will be used to calculate the local blood flow patterns and the arterial time-averaged wall shear stress at the bifurcated lesion level
Sponsors
Catholic University of the Sacred Heart
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with stable or unstable coronary artery disease; * TIMI 3 on both MV and SB; * MV visual diameter \> 2.5 mm; * SB visual diameter \> 2.0 mm; * Documentation of angiographically-critical (visually estimated percentage diameter stenosis ≥80% \<100%) coronary lesion treated by PCI and underwent post-PCI OCT assessment or angiographically-intermediate (visually estimated percentage diameter stenosis ranging between 30-80%) lesion in the MV considered suitable for conservative management (myocardial revascularization not planned).
Exclusion criteria
* Age \< 18 years or impossibility to give informed consent. * Female sex with child-bearing potential. * Life expectancy of less than 12 months or factors making clinical follow-up difficult (no fixed address, etc.). * Ascertained or suspected contraindications to prolonged (up to 6 month) double antiplatelet therapy. * Known hypersensitivity to aspirin, heparin, contrast dye, sirolimus, everolimus, zotarolimus, cobalt, chromium, nickel, tungsten acrylic, and fluoro-polymers. * Poor cardiac function as defined by left ventricular global ejection fraction ≤ 30%. * Recent (\< 48 hours) ST-segment elevation myocardial infarction. * Severe myocardial hypertrophy (interventricular septum thickness \> 15 mm, ECG Sokolow's criteria fulfilled). * Severe valvular heart disease. * Significant platelet count alteration (\<100,000 cells/mm3 or \> 700,000 cells/mm3). * Gastrointestinal bleeding requiring surgery or blood transfusions within 4 previous weeks. * History of clotting pathology. * Advance renal failure with glomerular filtration rate \< 30 ml/min (Cockcroft-Gault equation) * Left main lesion. * Target bifurcation located on a distal coronary segment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Target bifurcation failure (TBF) | 1,6,12,18,24 and 36 months | \- Target bifurcated lesion-related major adverse coronary event (MACE) defined as the composite of: * cardiac death * myocardial infarction (MI) not clearly related with another vessel * target vessel revascularization (TVR) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Target vessel failure | 1,6,12,18,24 and 36 months | \- In the absence of target bifurcated lesion-related MACE, target bifurcated lesion angiographic failure defined, in patients treated by PCI, as: \> 50% restenosis on the main vessel (MV) or TIMI (Thrombolysis In Myocardial Infarction) flow \< 3 on the side branch (SB) at angiography eventually performed during the clinical course. |
| Bifurcated lesion angiographic failure | 1,6,12,18,24 and 36 months | * Cardiac death * MI * TVR * Definite or probable stent thrombosis |
Countries
Italy
Contacts
Primary ContactFrancesco Burzotta, MD
Outcome results
None listed