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

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...

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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
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container_issue 2
container_start_page 204
container_title Journal of the American College of Cardiology
container_volume 45
creator FASSA, Amir-Ali
WAGATSUMA, Kenji
HIGANO, Stuart T
MATHEW, Verghese
BARSNESS, Gregory W
LENNON, Ryan J
HOLMES, David R
LERMAN, Amir
description 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.
doi_str_mv 10.1016/j.jacc.2004.09.066
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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 &lt;7.5 mm(2), and 131 (61.2%) an MLA &gt; or =7.5 mm(2). Left main coronary artery revascularization was performed in 85.5% (71 of 83) of patients with an MLA &lt;7.5 mm(2) and deferred in 86.9% (114 of 131) of patients with an MLA &gt; 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 &lt;7.5 mm(2) who underwent revascularization and those with an MLA &gt; 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. 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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 &lt;7.5 mm(2) who underwent revascularization and those with an MLA &gt; 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 &gt; or =7.5 mm(2) appears to be safe.</description><subject>Aged</subject><subject>Angina pectoris</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. 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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 &lt;7.5 mm(2) who underwent revascularization and those with an MLA &gt; 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 &gt; or =7.5 mm(2) appears to be safe.</abstract><cop>New York, NY</cop><pub>Elsevier Science</pub><pmid>15653016</pmid><doi>10.1016/j.jacc.2004.09.066</doi><tpages>8</tpages></addata></record>
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source BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS
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
title Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease : A long-term follow-up study
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