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J Am Coll Cardiol, 2005; 45:204-211, doi:10.1016/j.jacc.2004.09.066 © 2005 by the American College of Cardiology Foundation |
Center of Coronary Physiology and Imaging, Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
Manuscript received May 27, 2004; revised manuscript received September 24, 2004, accepted September 28, 2004.
* Reprint requests and correspondence: Dr. Amir Lerman, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: lerman.amir{at}mayo.edu).
OBJECTIVES: 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.
BACKGROUND: The assessment of LMCA lesions using coronary angiography is often challenging; IVUS provides useful information for assessment of coronary disease.
METHODS: 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.
RESULTS: The lower range of normal LMCA MLA was 7.5 mm2. Of the patients with angiographically indeterminate LMCAs, 83 (38.8%) had an MLA <7.5 mm2, and 131 (61.2%) an MLA
7.5 mm2. Left main coronary artery revascularization was performed in 85.5% (71 of 83) of patients with an MLA <7.5 mm2 and deferred in 86.9% (114 of 131) of patients with an MLA
7.5 mm2. 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 mm2 who underwent revascularization and those with an MLA
7.5 mm2 deferred for revascularization (p = 0.28). Based on outcome, the best cut-off MLA by receiver operating characteristic was 9.6 mm2. Multivariate predictors of cardiac events were age, smoking, and number of non-LMCA vessels diseased.
CONCLUSIONS: 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 mm2 appears to be safe.
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