IVUS / Abizaid

Long-term follow-up after percutaneous transluminal coronary angioplasty was not performed based on intravascular ultrasound findings: importance of lumen dimensions.

Abizaid AS, Mintz GS, Mehran R, Abizaid A, Lansky AJ, Pichard AD, Satler LF, Wu H, Pappas C, Kent KM, Leon MB.

Circulation. 1999 Jul 20; 100(3):256-61.

OBJECTIVES:

The purposes of the study were (1) to determine the event rate in patients with chest pain and angiographically intermediate de novo native coronary artery lesions after intervention was deferred on the basis of IVUS findings and (2) to identify the clinical, angiographic, and IVUS predictors of late cardiac events in these patients.

METHODS:

• 300 patients
• Intervention was deferred based on intravascular ultrasound (IVUS) findings (MLA ≥ 4 mm²) or a minimum lumen diameter (MLD) ≥ 2.0 mm
• Standard clinical, angiographic, and IVUS parameters were collected
• Parameters tested in multivariate models were diabetes mellitus, IVUS lesion lumen area, maximum lumen diameter, minimum lumen diameter, plaque area, plaque burden, and area stenosis (AS)
• Mean follow-up time of 13 months (range 1 to 24 months)

SUMMARY:

• Events occurred in 24 patients (8 %).
• No angiographic measurement was significant at P < 0.05.
• The only independent predictors of an event (death, myocardial infarction, or TLR) were IVUS minimum lumen area and AS.
• The only independent predictors of TLR were diabetes mellitus, IVUS minimum lumen area, and AS.
• In 248 lesions with a minimum lumen area ≥ 4.0 mm², the event rate was only 4.4 % and the TLR rate 2.8 %.

CONCLUSIONS:

A low event rate during follow-up after IVUS-based deferred coronary interventions existed in patients with de novo intermediate native artery lesions. IVUS minimum lumen CSA was the major anatomic predictor of events. In patients with a minimum lumen CSA ≥ 4.0 mm², the event rate was especially low. IVUS imaging is an acceptable alternative to physiological assessment in these patients.

ABIZAID ARTICLE SUMMARY ( DOWNLOAD PDF )

Click here to return to our Clinical Paper Summaries main page.