Image Content Analysis of Dural-axis Rotational Versus Standard Coronary Angiography

• Diagnosis of Coronary Heart Disease [ Time Frame: After the patient enrolment, an expected average of 1 week ] [ Designated as safety issue: No ]
  The number of patients diagnosed as coronary heart disease by either angiographic modality by two blinded independent reviewers are recorded. The single criterion for diagnosis of coronary heart disease is the presence of coronary artery stenoses greater than or equal to 50%.
  
  
• Coronary Lesion Assessment [ Time Frame: After the patient enrolment, an expected average of 1 week ] [ Designated as safety issue: No ]
  The number of lesions greater than or equal to 50% detected by either angiographic modality by two blinded independent reviewers are recorded.In addition, they are asked to comment on the characteristics of the >50% lesions (number of coronary lesions, number of bifurcation lesions, location of lesion, multivessel disease, American College of Cardiology (ACC) lesion classification and Medina classification for bifurcation lesions)
  
  
• Diagnostic Screening Adequacy [ Time Frame: After the patient enrolment, an expected average of 1 week ] [ Designated as safety issue: No ]
  Two different experienced reviewers analyzed the angiographic sets based on a Likert Scale for each vessel segment, calcification, thrombolysis in myocardial infarction (TIMI) flow, collaterals, displaying the lesions and bifurcations.
  
  
• Quantitative Coronary Angiography [ Time Frame: After the patient enrolment, an expected average of 1 week ] [ Designated as safety issue: No ]
  The quantitative coronary angiography analysis of the >50% lesions detected by the lesion assessment of both angiographic modalities (lesion length, minimum lumen diameter, diameter stenosis).
  
  

• Safety Analysis [ Time Frame: During coronary angiography ] [ Designated as safety issue: Yes ]
  The time(seconds), contrast usage(ml) and radiation dose(Gycm2) are recorded from the point of selective catheter engagement in the coronary ostium to the completion of the diagnostic study. The time, contrast and radiation to perform isocentering are included during dura-axis rotational coronary angiography. The time, contrast and radiation to engage the coronary ostium, exchange catheters, and perform non-coronary angiography are excluded from the analysis. All adverse events observed by the operator or reported by the patient are recorded.
  
  

The prior studies have demonstrated that dual-axis rotational coronary angiography (DARCA) is associated with lower contrast usage and radiation exposure compared with standard coronary angiography (SA). Single-axis rotational coronary angiography (RA) has been proved by previous studies without any reduction in diagnostic accuracy compared to SA. However, the rotational protocol is obvious different between DARCA and single-axis RA. A recent study has assessed the diagnostic accuracy of DARCA, but this study was not designed for image content analysis and the number of patients included did not provide sufficient statistical power to allow a valid comparison of DARCA with SA. The diagnostic accuracy of DARCA aroused our attention.