Comparison of Computed Tomography Angiography Versus Invasive Angiography to Assess Medina Classification in Coronary
Kajetan Grodecki1, Maksymilian P Opolski2, Adam D Staruch2
1Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland.
Insights
Coronary computed tomography angiography (CTA) shows moderate agreement for Medina classification, improving reproducibility compared to invasive coronary angiography (ICA). Medina class predicts side branch occlusion after percutaneous coronary intervention, regardless of imaging modality.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- The Medina classification assesses coronary bifurcation stenosis using invasive coronary angiography (ICA).
- The utility of coronary computed tomography angiography (CTA) for Medina classification is not well-established.
- Predicting side branch (SB) occlusion after percutaneous coronary intervention (PCI) is crucial for procedural success.
Purpose of the Study:
- To compare the agreement and reproducibility of Medina classification between ICA and coronary CTA.
- To evaluate the ability of Medina classification, assessed by both modalities, to predict SB occlusion following PCI.
Main Methods:
- A total of 363 patients with 400 coronary bifurcations were analyzed.
- Medina classification was assessed using both ICA and coronary CTA.
- Interobserver agreement and prediction of SB occlusion were evaluated.
Main Results:
- Total agreement between CTA and ICA for Medina class was poor (kappa=0.189), with discordance in 63.3% of lesions.
- Interobserver agreement was moderate for CTA (kappa=0.557) and fair for ICA (kappa=0.346).
- Medina class 1.X.1 (proximal involvement of main vessel and SB) predicted SB occlusion similarly for both modalities (AUC 0.686 for CTA vs. 0.663 for ICA).
Conclusions:
- Medina classification agreement is significantly affected by the imaging modality.
- Coronary CTA offers improved reproducibility for Medina classification compared to ICA.
- Both CTA and ICA-derived Medina class 1.X.1 are predictive of SB occlusion post-PCI.
Abstract:
The Medina classification is used to determine the presence of significant stenosis (≥50%) within each of the 3 arterial segments of coronary bifurcation in invasive coronary angiography (ICA). The utility of coronary computed tomography angiography (coronary CTA) for assessment of Medina classification is unknown. We aimed to compare the agreement and reproducibility of Medina classification between ICA and coronary CTA, and evaluate its ability to predict side branch (SB) occlusion following percutaneous coronary intervention (PCI). In total 363 patients with 400 bifurcations were included, and 28 (7%) SB occlusions among 26 patients were noted. Total agreement between CTA and ICA for assessment of Medina class was poor (kappa = 0.189), and discordance between both modalities was noted in 253 (63.3%) lesions. Larger diameter ratio between main vessel and SB in CTA, and larger bifurcation angle in ICA were independently associated with discordant Medina assessment. Whereas the interobserver agreement on Medina classification in CTA was moderate (kappa = 0.557), only fair agreement (kappa = 0.346) was observed for ICA. Finally, Medina class with any proximal involvement of main vessel and SB (1.X.1) on CTA or ICA was the most predictive of SB occlusion following PCI with no significant differences between both modalities (area under the curve 0.686 vs 0.663, p = 0.693, respectively). In conclusion, Medina classification was significantly affected by the imaging modality, and coronary CTA improved reproducibility of Medina classification compared with ICA. Both CTA and ICA-derived Medina class with any involvement of the proximal main vessel and SB was predictive of SB occlusion following PCI.
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