TY - JOUR
T1 - Intravascular ultrasound-guided treatment for angiographically indeterminate left main coronary artery disease
T2 - A long-term follow-up study
AU - Fassa, Amir Ali
AU - Wagatsuma, Kenji
AU - Higano, Stuart T.
AU - Mathew, Verghese
AU - Barsness, Gregory W.
AU - Lennon, Ryan J.
AU - Holmes, David R.
AU - Lerman, Amir
N1 - Funding Information:
This work was supported by the National Institutes of Health (R01 HL63911, R01 HL69840) and the Miami Heart Research Institute. Dr. Fassa is the recipient of the Zahedi Family Visiting Clinician Scholarship at the Mayo Foundation.
PY - 2005/1/18
Y1 - 2005/1/18
N2 - 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 <7.5 mm 2, and 131 (61.2%) an MLA <7.5 mm 2. Left main coronary artery revascularization was performed in 85.5% (71 of 83) of patients with an MLA <7.5 mm 2 and deferred in 86.9% (114 of 131) of patients with an MLA <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 <7.5 mm 2 who underwent revascularization and those with an MLA <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 <7.5 mm 2 appears to be safe.
AB - 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 <7.5 mm 2, and 131 (61.2%) an MLA <7.5 mm 2. Left main coronary artery revascularization was performed in 85.5% (71 of 83) of patients with an MLA <7.5 mm 2 and deferred in 86.9% (114 of 131) of patients with an MLA <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 <7.5 mm 2 who underwent revascularization and those with an MLA <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 <7.5 mm 2 appears to be safe.
UR - http://www.scopus.com/inward/record.url?scp=11844250021&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=11844250021&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2004.09.066
DO - 10.1016/j.jacc.2004.09.066
M3 - Article
C2 - 15653016
AN - SCOPUS:11844250021
SN - 0735-1097
VL - 45
SP - 204
EP - 211
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -