Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography

Aims: To compare the performance of 64-slice computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) in the detection and classification (according to the Medina system) of bifurcation lesions (BLs). Methods and results: We studied 323 consecutive patients undergoing 64-slice CTCA prior to ICA. All coronary segments ≥2 mm in diameter were evaluated for the presence of a significant (≥50% diameter reduction on quantitative coronary angiography) BL. Evaluation of BL by CTCA included the assessment of significant lumen obstruction in both main and side branch vessels. Forty-one out of 43 patients (46/48 lesions) with significant BL were identified by CTCA. Excluding coronary segments with non-diagnostic image quality (5%), the sensitivity, specificity, and positive and negative predictive values of CTCA for detecting significant BL were 96, 99, and 85 and 99%, respectively. In 39 of these 41 patients, CTCA assessment was concordant with the Medina lesion classification on ICA. Conclusion: Sixty-four-slice CTCA allows accurate assessment of complex BL.