QUANTITATIVE CORONARY ANGIOGRAPHY VERSUS VISUAL ESTIMATION FROM CINE-FILM OR PHARMACOLOGICAL STRESS PERFUSION IMAGES

Visual judgment of stenosis severity from cine-film or single-photon e mission computed tomographic dipyridamole perfusion images was compare d to assessment of stenosis severity as measured with digital quantita tive coronary angiography. Thirty patients with angiographically verif ied single-vessel disease underwent dipyridamole thallium stress testi ng within 90 days of angiography. Results A percent diameter stenosis of greater than or equal to 50%, a percent area stenosis of greater th an or equal to 75%, and a stenotic flow reserve of <3.75 measured by q uantitative coronary angiography (CMS, version 1.1, Medis Inc.) corres ponded to haemodynamically significant stenosis as evaluated by visual estimates from cine-film or perfusion images. Quantitative coronary a ngiography percent diameter stenosis (51.2%+/-12.6%) correlated closel y (r=0.74) but underestimated significantly visual assessment of steno sis severity from cine-film (69.3%+/-21.2%; P=0.0001). However, quanti tative coronary angiography percent area stenosis (74.7%+/-11.7%) more closely reflected visual estimates from cine-film (P=0.19). Quantitat ive coronary angiography stenotic flow reserve showed the highest posi tive and negative predictive value regarding visual estimates from cin e-film (88%, 86%) or perfusion images (88%, 64%) followed by percent d iameter stenosis (86%, 75% 86%, 56%) and percent area stenosis (87%, 8 0%, 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.