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CLINICAL STUDIES

One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms

^a Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, the Washington Hospital Center, Washington, DC, USA

Manuscript received June 8, 1998; revised manuscript received April 2, 1999, accepted May 14, 1999.

Reprint requests and correspondence: Dr. Gary S. Mintz, Coronary Ultrasound Program, Washington Hospital Center, 110 Irving Street Suite 4B-1, Washington, DC 20010
GSM1{at}MHG.EDU

OBJECTIVES

The purpose of this study was to correlate angiographic and intravascular ultrasound (IVUS) findings in left main coronary artery (LMCA) disease and identify the predictors of coronary events at one year in patients with LMCA stenoses.

BACKGROUND

Significant (50% diameter stenosis [DS]) LMCA disease has a poor long-term prognosis.

METHODS

One hundred twenty-two patients who underwent angiographic and IVUS assessment of the severity of LMCA disease and who did not have subsequent catheter or surgical intervention were followed for one year. Standard clinical, angiographic and IVUS parameters were collected.

RESULTS

The quantitative coronary angiography (QCA) reference diameter (3.91 ± 0.76 mm, mean ± 1 SD) correlated moderately with IVUS (4.25 ± 0.78 mm, r = 0.492, p = 0.0001). The lesion site minimum lumen diameter (MLD) (2.26 ± 0.82 mm) by QCA correlated less well with IVUS (2.8 ± 0.82 mm, r = 0.364, p = 0.0005). The QCA DS measured 42 ± 16%. During the follow-up period, 4 patients died, none had a myocardial infarction, 3 underwent catheter-based LMCA intervention and 11 underwent bypass surgery. Univariate predictors of events (p < 0.05) were diabetes, presence of another lesion whether treated with catheter-based intervention or untreated with DS > 50% and IVUS reference plaque burden and lesion lumen area, maximum lumen diameter, MLD, plaque area and area stenosis. Using logistic regression analysis diabetes mellitus, an untreated vessel (with a DS > 50%) and IVUS MLD were independent predictors of cardiac events.

CONCLUSIONS

In selected patients assessed by IVUS, moderate LMCA disease had a one-year event rate of only 14%. Intravascular ultrasound MLD was the most important quantitative predictor of cardiac events. For any given MLD, the event rate was exaggerated in the presence of diabetes or another untreated lesion (>50% DS).

Abbreviations and Acronyms   AS = area stenosis   CABG = coronary artery bypass graft   CASS = Coronary Artery Surgery Study   CSA = cross-sectional area   CSN = cross-sectional narrowing   DS = diameter stenosis   ECSS = European Coronary Surgical Study   EEM = external elastic membrane   IVUS = intravascular ultrasound   LMCA = left main coronary artery   MI = myocardial infarction   MLD = minimum lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   P&M = plaque & media   QCA = quantitative coronary angiography   VA = Veterans Administration Cooperative Study of Coronary Artery Bypass Surgery

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