standard vs. 3-dimensional coronary angiography: a paired comparison

Conditions: Coronary Artery Disease

Summary: aim of this study is to evaluate whether the length of coronary segments, assessed by an experienced operator, using the "optimal view" of standard 2-dimensional coronary angiography, is over/underestimated with respect to the one evaluated automatically with the help of a 3-dimensional coronary reconstruction model. moreover, both techniques are compared with an "in-vivo" surrogate of the real length of the coronary segment under evaluation, i.e. an intra-coronary marker guide-wire, which is a wire with markers placed at fixed and known distance along its length in its distal (intra-coronary) part. two hypotheses are tested: (1) the length of a coronary segment evaluated with a standard 2-dimensional "optimal view" over/underestimates the length assessed by a 3-dimensional coronary model that automatically detects the least foreshortened length of the segment under evaluation, and (2) the 3-dimensional model approximates more closely than standard 2-dimensional angiography, the real length of the segment detected by the marker guide-wire.

the potential to improve the accuracy of the assessment of the coronary tree by means of 3-d modeling reconstruction may lead to an evaluation of the coronary artery anatomy that approximates more correctly the real anatomy, thus subsequently leading to a more tailored diagnosis and therapy for the patients with ischemic heart disease. aim of the current study is to assess whether a 3-d model of the coronary tree offers a less foreshortened and less operator-dependent evaluation of the length of the coronary arteries with respect to standard coronary angiography. furthermore, for the first time "in-vivo", a comparison with the "real" length of the vessel will be performed using as "gold standard" an intra-coronary guide-wire with radiopaque markers at fixed and known distance one from the other along its distal part.

Eligibility criteria:
inclusion criteria: clinical * age \> 18 years. * ability to give informed consent. * clinical evidence of coronary artery disease: * recent (\< 72 hours) acute myocardial infarction, * stable angina with documented positive stress test, * unstable angina with documented ischemia (positive ecg or troponin test or documented positive stress test). angiographic * eligibility for pci in at least one de-novo stenosis in a native coronary artery, after the index angiogram. * planned pci according to a previous coronary angiogram. exclusion criteria: clinical * pregnancy. * chronic or acute renal failure (serum creatinine \> 1.8 mg/dl or hemodialysis). * urgent procedure (a procedure carried out before the next referring day, for example for acute myocardial infarction, unstable angina refractory to medical therapy or cardiogenic shock). * contraindications or known hypersensitivity to contrast media. * enrollment in another study protocol. angiographic * significant left main coronary artery disease. * pci for a total occlusion of a major coronary vessel (lad, lcx or rca). * extensive thrombotic burden in a coronary lesion (thrombus grade 3/4). * timi flow \<3 distal to the lesion.