Assessing coronary stenosis. Quantitative coronary angiography versus visual estimation from cine-film or pharmacological stress perfusion images

Abstract

Visual judgment of stenosis severity from cine-film or single-photon emission computed tomographic dipyridamole perfusion images was compared to assessment of stenosis severity as measured with digital quantitative coronary angiography. Thirty patients with angiographically verified single-vessel disease underwent dipyridamole thallium stress testing within 90 days of angiography. Results. A percent diameter stenosis of ≤ 50%, a percent area stenosis of ≤ 75%, and a stenotic flow reserve of < 3.75 measured by quantitative coronary angiography (CMS, version 1.1, Medis Inc.) corresponded to haemodynamically significant stenosis as evaluated by visual estimates from cine-film or perfusion images. Quantitative coronary angiography percent diameter stenosis (51.2% ± 12.6%) correlated closely (r = 0.74) but underestimated significantly visual assessment of stenosis severity from cine-film (69.3% ± 21.2%; P= 0.0001). However, quantitative coronary angiography percent area stenosis (74.7% ± 11.7%) more closely reflected visual estimates from cine-film (P = 0.19). Quantitative coronary angiography stenotic flow reserve showed the highest positive and negative predictive value regarding visual estimates from cine-film (88%, 86%) or perfusion images (88%, 64%) followed by percent diameter stenosis (86%, 75% 86%, 56%) and percent area stenosis (87%, 80%, 87%, 60%), respectively. Conclusion. Evaluation of coronary lesions by quantitative coronary angiography corresponds closely with visual estimates from cine-film and haemodynamic significance as evaluated by dipyridamole perfusion images.