IVUS / Fassa
Intravascular Ultrasound-Guided Treatment for Angiographically Indeterminate Left Main Coronary Artery Disease
Fassa AA, Wagatsuma K, Higano ST, Mathew V, Barsness GW, Lennon RJ, Holmes DR Jr, Lerman A. J Am Coll Cardiol.
2005 Jan 18; 45(2):204-11.
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.
- 214 patients
- IVUS was performed on 121 patients with angiographic-ally normal LMCAs to determine the lower range of normal minimum lumen area (MLA), defined as the mean - 2 SD
- IVUS studies on 214 patients with angiographically indeterminate LMCA lesions were conducted
- Deferral of revascularization was recommended when the MLA was larger than the predetermined value
- 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.
The study shows that IVUS is a safe method to accurately assess the degree of disease in the LMCA that appears indeterminate by angiography. It also suggests that an IVUS-guided treatment strategy based on deferral of revascularization in patients with MLA ≥ 7.5 mm² is safe.
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