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CLINICAL STUDIES

Greater late lumen loss after successful coronary balloon angioplasty in the proximal left anterior descending coronary artery is not explained by extent of vessel wall damage or plaque burden

Wouter E. M. Kok, MD^*, Ron J. G. Peters, MD, Gerard Pasterkamp, MD, Carlo Di Mario, MD, Patrick W. Serruys, MD, FACC^¶, Martin Prins, MD^#, Cees A. Visser, MD, FACC^* for the PICTURE study group^g

^* Department of Cardiology, Free University Hospital Amsterdam, Amsterdam, the Netherlands
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
the Heart Lung Institute, Utrecht University Hospital, Utrecht, the Netherlands
Department of Cardiology, Centro Cuore Columbus, Milan, Italy
^¶ Department of Cardiology, University Hospital Rotterdam, Rotterdam, the Netherlands
^# Department of Clinical Epidemiology, Academic Medical Center, Amsterdam, the Netherlands
^g for the PICTURE study group, Interuniversity Cardiology Institute, Utrecht, the Netherlands

Manuscript received August 24, 1998; revised manuscript received September 20, 1999, accepted October 25, 1999.

Reprint requests and correspondence: Dr. Ron J.G. Peters, Department of Cardiology, F3-236, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam Z-O
rjpeters{at}amc.uva.nl

OBJECTIVES

We investigated whether the greater late lumen loss after coronary balloon angioplasty in the proximal left anterior descending artery (P-LAD) compared with that in other segments might be related to differences in vascular dimensions or morphology as determined by angiography and intravascular ultrasound imaging.

BACKGROUND

The greater late lumen loss after angioplasty in the P-LAD that has been observed in several studies has not been explained.

METHODS

We studied 178 patients and 194 coronary artery lesions by quantitative angiography and 30 MHz intravascular ultrasound imaging after successful balloon angioplasty. Vessel wall morphology was compared among three proximal and three nonproximal segments. Follow-up quantitative angiography for late lumen loss calculation was performed in 168 lesions. Multivariate analysis was used to determine predictors of late lumen loss.

RESULTS

Absolute and relative late loss were significantly greater at the P-LAD compared with the pooled group of other segments (0.42 ± 0.60 mm vs. 0.10 ± 0.48 mm, p = 0.0008 and 0.14 ± 0.24 vs. 0.03 ± 0.17, p < 0.001). Also, a greater percentage of calcific lesions (65% vs. 44%, p = 0.034), a lower incidence of rupture (51% vs. 74%, p = 0.009) and a larger reference segment plaque area (5.4 ± 2.2 mm² vs. 4.7 ± 1.9 mm², p = 0.05) were found in the P-LAD. In multivariate analysis however, these variables were not predictive of late loss.

CONCLUSIONS

Greater late lumen loss after coronary balloon angioplasty of the P-LAD is not explained by differences in atherosclerotic plaque burden or in vessel wall damage.

Abbreviations and Acronyms   ANOVA = analysis of variance   CV = coefficient of variation   IVUS = intravascular ultrasound imaging   MLD = minimal lumen diameter   P-LAD = proximal left anterior descending artery   PTCA = percutaneous transluminal coronary angioplasty   SD = standard deviation