Software for Optimal Sequencing of Endovascular Correction of Three-Vessel Coronary Disease in Patients with Acute Myocardial Ischemia
Selection of inadequate algorithm for endovascular correction of three-vessel coronary disease leads to an increase in the number of adverse cardiac events in patients with acute myocardial ischemia.
The aim of the study is to evaluate the efficacy of the developed software for optimal sequencing of correction of three affected coronary territories in patients with acute myocardial ischemia and three-vessel coronary disease.
Materials and Methods. Treatment results were evaluated in 101 patients with acute coronary syndrome (ACS). Correlation analysis was performed in all patients to determine the sequence of correction for three affected coronary territories as proposed by the operating surgeon, three independent experts or recommended by the developed computer programs “Sapphire 2015 — Right dominance” and “Sapphire 2015 — Left dominance”.
Results. Exact similarity in endovascular correction strategies proposed by the software and experts was observed in 72 patients (71.3%); partial similarity — in 28 (27.7%); total difference — in 1 patient (1.0%) (n=101; R=0.864; 
=0.822; p=0.000002). Exact similarity in endovascular correction strategies offered by the software and the operating surgeon was observed in 39 patients (38.7%); partial similarity — in 55 (54.5%); total difference — in 7 (6.9%) (n=101; R=0.836; =0.677; p=0.000001). However, early postoperative mortality was reported in those ACS patients for whom there was selected non-optimal sequence of correcting three affected coronary territories during the intervention as recommended by the software.
Conclusion. It is reasonable to use the developed software “Sapphire 2015 — Right dominance” and “Sapphire 2015 — Left dominance” to select the optimal sequence for correction of three-vessel coronary disease in patients with ACS.
- Smits P.C., Assaf A., Richardt G., Omerovic E., Abdel-Wahab M., Neumann F.J. Design and rationale of the COMPARE-ACUTE trial: fractional flow reserve-guided primary multivessel percutaneous coronary intervention to improve guideline indexed actual standard of care for treatment of ST-elevation myocardial infarction in patients with multivessel coronary disease. Am Heart J 2017; 186: 21–28, https://doi.org/10.1016/j.ahj.2016.12.016.
- Naqvi S.Y., Klein J., Saha T., McCormick D.J., Goldberg S. Comparison of percutaneous coronary intervention versus coronary artery bypass grafting for unprotected left main coronary artery disease. Am J Cardiol 2017; 119(4): 520–527, https://doi.org/10.1016/j.amjcard.2016.11.003.
- Droppa M., Vaduganathan M., Venkateswaran R.V., Singh A., Szumita P.M., Roberts R.J., Qamar A., Hack L., Rath D., Gawaz M., Fuernau G., de Waha-Thiele S., Desch S., Schneider S., Ouarrak T., Jaffer F.A., Zeymer U., Thiele H., Bhatt D.L., Geisler T. Cangrelor in cardiogenic shock and after cardiopulmonary resuscitation: a global, multicenter, matched pair analysis with oral P2Y12 inhibition from the IABP-SHOCK II trial. Resuscitation 2019; 137: 205–212.
- Xu H., Zhang X., Li J., Liu H., Hu X., Yang J. Complete versus culprit-only revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: a meta-analysis of randomized trials. BMC Cardiovasc Disord 2019; 19(1): 91–107, https://doi.org/10.1186/s12872-019-1073-8.
- Gaffar R., Habib B., Filion K.B., Reynier P., Eisenberg M.J. Optimal timing of complete revascularization in acute coronary syndrome: a systematic review and meta-analysis. J Am Heart Assoc 2017; 6(4): e005381, https://doi.org/10.1161/jaha.116.005381.
- Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Международный журнал интервенционной кардиоангиологии 2014; 37: 49–55. Petrosyan Yu.S., Ioseliani D.G. About the total assessment of the condition of the coronary bed in patients with coronary heart disease. Mezdunarodnyj zurnal intervencionnoj kardioangiologii 2014; 37: 49–55.
- Петров В.И., Недогода С.В. Медицина, основанная на доказательствах. М: Гэотар-Медиа; 2009; 144. Petrov V.I., Nedogoda S.V. Meditsina, osnovannaya na dokazatel’stvakh [Evidence-based medicine]. Moscow: Geotar-Media; 2009.
- Scholz K.H., Maier S.K.G., Maier L.S., Lengenfelder B., Jacobshagen C., Jung J., Fleischmann C., Werner G.S., Olbrich H.G., Ott R., Mudra H., Seidl K., Schulze P.C., Weiss C., Haimerl J., Friede T., Meyer T. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J 2018; 39(13): 1065–1074, https://doi.org/10.1093/eurheartj/ehy004.
- Secemsky E.A., Yeh R.W. Complete vs incomplete revascularization during percutaneous coronary intervention and improved survival — the key is immortality. JAMA Cardiol 2018; 3(5): 443–444, https://doi.org/10.1001/jamacardio.2018.0078.
- Fukutomi M., Toriumi S., Ogoyama Y., Oba Y., Takahashi M., Funayama H., Kario K. Outcome of staged percutaneous coronary intervention within two weeks from admission in patients with ST-segment elevation myocardial infarction with multivessel disease. Catheter Cardiovasc Interv 2019; 93(5): E262–E268, https://doi.org/10.1002/ccd.27896.
