2 research outputs found
Neural network-based coronary dominance classification of RCA angiograms
Background. Cardiac dominance classification is essential for SYNTAX score
estimation, which is a tool used to determine the complexity of coronary artery
disease and guide patient selection toward optimal revascularization strategy.
Objectives. Cardiac dominance classification algorithm based on the analysis of
right coronary artery (RCA) angiograms using neural network Method. We employed
convolutional neural network ConvNext and Swin transformer for 2D image
(frames) classification, along with a majority vote for cardio angiographic
view classification. An auxiliary network was also used to detect irrelevant
images which were then excluded from the data set. Our data set consisted of
828 angiographic studies, 192 of them being patients with left dominance.
Results. 5-fold cross validation gave the following dominance classification
metrics (p=95%): macro recall=93.1%, accuracy=93.5%, macro F1=89.2%. The most
common case in which the model regularly failed was RCA occlusion, as it
requires utilization of LCA information. Another cause for false prediction is
a small diameter combined with poor quality cardio angiographic view. In such
cases, cardiac dominance classification can be complex and may require
discussion among specialists to reach an accurate conclusion. Conclusion. The
use of machine learning approaches to classify cardiac dominance based on RCA
alone has been shown to be successful with satisfactory accuracy. However, for
higher accuracy, it is necessary to utilize LCA information in the case of an
occluded RCA and detect cases where there is high uncertainty
Long-term clinical outcomes after kissing balloon inflation in patients with coronary bifurcation lesions treated with provisional stenting technique. Results from the real-world multicenter registry
Objective: There is a lack of data regarding the long-term clinical efficacy of the kissing balloon inflation (KBI) after provisional stenting of coronary bifurcation lesions. The aim of this study was to analyze the impact of KBI on long-term clinical outcomes in patients undergoing provisional stenting for the coronary bifurcation lesions in a large real-world population. Methods: A total of 873 patients who underwent percutaneous coronary interventions (PCI) with provisional stenting and had clinical follow up were analyzed. Patients treated with 2-stent strategy were excluded. To reduce the effect of potential confounding factors in this observational study, propensity score matching was conducted. Results: KBI was performed in 325 patients (37.2%). The median follow-up duration was 37.3 months. Patients treated with KBI more often had a previous PCI (48.6% vs. 42.5% SMD = 0.123). Patients in non-kissing group had more complex coronary disease with higher prevalence of calcification (14.8% vs. 21.4% SMD = 0.172), thrombosis (2.8% vs. 5.8% SMD = 0.152) and longer side branch lesions (8.3% vs. 11.7% SMD = 0.113). There were no significant differences in the major adverse cardiac events including death, myocardial infarction, target lesion revascularization after KBI versus no KBI (15.4% vs. 15.7%, p = 0.28), in total cohort or in matched patients (17.1% vs. 15.8%, adjusted HR 1.01, 95% CI: 0.65–1.65, p = 0.95). The lack of effect of KBI on clinical outcomes was consistent across various subgroups including left main disease. Conclusion: In this multicenter real-world registry, KBI did not improve long-term clinical outcomes in patients with coronary bifurcation lesions treated with provisional stenting technique