Comparison of Intravascular Ultrasound to Contrast-Enhanced 64-Slice Computed Tomography to Assess the Significance of Angiographically Ambiguous Coronary Narrowings

• Published in: The American journal of cardiology 2008-10, Vol.102 (8), p.994-1001
• Main Authors: Okabe, Teruo, MD, Weigold, Wm. Guy, MD, Mintz, Gary S., MD, Roswell, Robert, MD, Joshi, Subodh, MD, Lee, Sung Yun, MD, Lee, Bongryeol, MD, Steinberg, Daniel H., MD, Roy, Probal, MD, Pinto Slottow, Tina L., MD, Smith, Kimberly, BS, Torguson, Rebecca, MPH, Xue, Zhenyi, MS, Satler, Lowell F., MD, Kent, Kenneth M., MD, PhD, Pichard, Augusto D., MD, Weissman, Neil J., MD, Lindsay, Joseph, MD, Waksman, Ron, MD
• Format: Article
• Language: English
• Subjects: Angioplasty; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Contrast Media - administration & dosage; Coronary Angiography; Coronary heart disease; Coronary Stenosis - diagnosis; Coronary vessels; Diagnosis, Differential; Female; Follow-Up Studies; Heart; Heart surgery; Humans; Injections, Intravenous; Iopamidol - administration & dosage; Male; Medical imaging; Medical sciences; Middle Aged; Pathology; Regression analysis; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed - methods; Ultrasonography, Interventional - methods
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.05.066

The efficacy of contrast-enhanced multislice computed tomography (MSCT) for assessment of ambiguous lesions is unknown. We compared both quantitative coronary angiography (QCA) and MSCT to the gold standard for a significant stenosis—minimum luminal area (MLA) by intravascular ultrasound (IVUS)—in 51 patients (64 ± 10 years old, 19 men) with 69 angiographically ambiguous, nonleft main lesions. The MSCT was performed 17 ± 18 days before IVUS analysis. Overall diameter stenosis by QCAwas 51.0 ± 9.8%; 39 of 51 patients (76%) eventually underwent revascularization (38 by percutaneous coronary intervention and 1 by coronary artery bypass graft). By univariate analysis, minimum luminal diameter, MLA, lumen visibility by MSCT, and minimum luminal diameter by QCA were significant predictors of MLA by IVUS ≤4.0 mm2 . In mildly calcified lesions (calcium burden by MSCT ≤1), MLA by MSCT was a much better predictor than in more calcified lesions. By multivariate logistic regression analysis, only MLA by MSCT (odds ratio 0.754, 95% confidence interval 0.571 to 0.995, p = 0.0458) was predictive of MLA by IVUS ≤4.0 mm2 . In conclusion, in angiographically ambiguous lesions in which QCA does not distinguish significantly from nonsignificant stenosis, MSCT-measured MLA can predict significant stenosis with MLA ≤4.0 mm2 measured by IVUS.