Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease : A long-term follow-up study

• Published in: Journal of the American College of Cardiology 2005-01, Vol.45 (2), p.204-211
• Main Authors: FASSA, Amir-Ali, WAGATSUMA, Kenji, HIGANO, Stuart T, MATHEW, Verghese, BARSNESS, Gregory W, LENNON, Ryan J, HOLMES, David R, LERMAN, Amir
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary heart disease; Coronary vessels; Female; Follow-Up Studies; Heart; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Reproducibility of Results; Time Factors; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.09.066

The purpose of this study was to evaluate the efficacy of an intravascular ultrasound (IVUS)-guided strategy for patients with angiographically indeterminate left main coronary artery (LMCA) disease. The assessment of LMCA lesions using coronary angiography is often challenging; IVUS provides useful information for assessment of coronary disease. Intravascular ultrasound was performed on 121 patients with angiographically normal LMCAs to determine the lower range of normal minimum lumen area (MLA), defined as the mean - 2 SD. We conducted IVUS studies on 214 patients with angiographically indeterminate LMCA lesions, and deferral of revascularization was recommended when the MLA was larger than this predetermined value. The lower range of normal LMCA MLA was 7.5 mm(2). Of the patients with angiographically indeterminate LMCAs, 83 (38.8%) had an MLA or =7.5 mm(2). Left main coronary artery revascularization was performed in 85.5% (71 of 83) of patients with an MLA or =7.5 mm(2). Long-term follow-up (mean 3.3 +/- 2.0 years) showed no significant difference in major adverse cardiac events (target vessel revascularization, acute myocardial infarction, and death) between patients with an MLA or =7.5 mm(2) deferred for revascularization (p = 0.28). Based on outcome, the best cut-off MLA by receiver operating characteristic was 9.6 mm(2). Multivariate predictors of cardiac events were age, smoking, and number of non-LMCA vessels diseased. Intravascular ultrasound is an accurate method to assess angiographically indeterminate lesions of the LMCA. Furthermore, deferring revascularization for patients with a minimum lumen area > or =7.5 mm(2) appears to be safe.