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STATE-OF-THE-ART PAPER AND COMMENTARY

Is Intravascular Ultrasound the Gold Standard Surrogate for Clinically Relevant Atherosclerosis Progression?

Cardiology Division, Department of Medicine, University of Washington School of Medicine, Seattle, Washington

Manuscript received August 15, 2006; accepted August 26, 2006.

^_* Reprint requests and correspondence: Dr. B. Greg Brown, University of Washington Clinical Trials Unit, Box 358855, 146 North Canal Street, Suite 200, Seattle, Washington 98195-8855. (Email: bgbrown{at}u.washington.edu).

Are progressive changes in intravascular ultrasound (IVUS)-derived indexes of plaque size sufficiently predictive of in-trial or future cardiovascular event risk that IVUS can serve as an efficient surrogate for clinical events in coronary disease trials? This question remains unanswered by clinical trials reported to date. Indeed, the answer may well be "yes." Nevertheless, there are enough concerns about the physical limitations, the fundamental assumptions, and the interpretation of the IVUS measurements that the answer cannot be taken for granted. Here, we review the evidence to date, discuss some of the concerns, and compare IVUS results with those of quantitative arteriography.

Abbreviations and Acronyms   IVUS = intravascular ultrasound   LDL = low-density lipoprotein   MI = myocardial infarction   QCA = quantitative coronary arteriography   %S = percent stenosis

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