Research paper Computed tomography angiography versus angiography for guiding percutaneous coronary interventions in bifurcation lesions e A prospective randomized pilot study Rafal Wolny a, * , Jerzy Pregowski a , Mariusz Kruk b , Cezary Kepka b , Gary S. Mintz c , Gabor G. Toth d , Artur Debski a , Michal Ciszewski a , Krzysztof Kukula a , Maksymilian P. Opolski a , Zbigniew Chmielak a , Adam Witkowski a a Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland b Department of Coronary and Structural Heart Disease, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland c Cardiovascular Research Foundation, 1700 Broadway, New York, 10019 NY, USA d University Heart Center Graz, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria article info Article history: Received 23 September 2016 Received in revised form 23 December 2016 Accepted 13 January 2017 Available online xxx Keywords: Coronary CTA Percutaneous coronary intervention Bifurcations Planning Side branch abstract Background: There is no data on the impact of coronary computed tomography angiography (coronary CTA), as an addition to angiography, on the outcomes of percutaneous coronary interventions (PCI) in bifurcation lesions. Methods: Patients with stable coronary artery disease scheduled for elective bifurcation PCI were ran- domized 1:1 to planning the procedure based on coronary CTA and angiography (CTA group) or angi- ography alone (CA group). The primary efficacy endpoint was the immediate angiographic result. Secondary efficacy endpoints were: a) procedural characteristics and b) postprocedural fractional flow reserve (FFR) in the side branch (SB) in a subgroup of patients. Safety outcomes were: a) periprocedural myocardial infarction, b) contrast use and c) radiation dose. Results: PCI of 45 lesions in the CTA group and 47 lesions in the CA group was performed. Postprocedural lumen diameters in the main branch (MB) and SB, frequency of SB compromise or occlusion and mean SB FFR values were not different between study groups. Two or more stents were implanted less frequently in the CTA group than in the CA group (18% vs. 43%, p ¼ 0.01). This difference was driven by less frequent MB 2-stent overlap in the CTA group (7 vs. 21%, p ¼ 0.046) and numerically less SB stenting (11% vs. 21%, p ¼ 0.07). Proximal optimization technique was used more frequently in the CTA group (44% vs. 21%, p ¼ 0.018). Conclusions: CTA-assisted bifurcation PCI leads to similar immediate results compared with angiography alone, however is associated with higher use of single-stent procedures with proximal optimization, less frequent 2-stent overlap and less SB stenting. © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. 1. Introduction Percutaneous coronary interventions (PCI) in bifurcation lesions are challenging procedures due to their technical complexity and higher risk of potential adverse effects, including in-stent reste- nosis, thrombosis and periprocedural myocardial infarction (MI). A side branch (SB) is involved in about 20% of all PCI procedures, which means that the issue of its optimization remains funda- mental. 1 Available data suggest that a one-stent crossover tech- nique with drug-eluting stent and provisional SB stenting has more favorable outcomes in comparison with a planned two-stent strategy. 2 Planning of bifurcation PCI is routinely based on visual estimation of coronary angiography. This approach has its limita- tions including assessment of vessel lumen only, suboptimal visu- alization of calcifications, vessel foreshortening and overlapping. Coronary computed tomography angiography (coronary CTA) is currently gaining recognition in coronary imaging, due to its high * Corresponding author. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, 42 Alpejska St, 04-628 Warsaw, Poland. Tel.: þ48 223434127. E-mail address: rwolny@ikard.pl (R. Wolny). Contents lists available at ScienceDirect Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com http://dx.doi.org/10.1016/j.jcct.2017.01.002 1934-5925/© 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved. Journal of Cardiovascular Computed Tomography xxx (2017) 1e10 Please cite this article inpress as: Wolny R, et al., Computed tomography angiography versus angiography for guiding percutaneous coronary interventions in bifurcation lesions e A prospective randomized pilot study, Journal of Cardiovascular Computed Tomography (2017), http:// dx.doi.org/10.1016/j.jcct.2017.01.002