Clinical decision making for intermediate coronary artery stenosis by myocardial perfusion imaging combined with intravascular ultrasound

Abstract

Objective To determine the predictors of angiographic and intravascular ultrasound (IVUS) parameters for ischemia in patients with intermediate coronary artery stenosis. Methods Patients with intermediate coronary artery disease (stenosis: 40%-70% by angiography) from MPI database of Nanjing First Hospital between March 2011 and December 2013 were retrospectively analyzed. All patients underwent MPI, quantitative CAG (QCA) and IVUS. Functional ischemia was defined as a locus of reversible perfusion defect detected by MPI in the territory of the coronary artery having intermediate stenosis. The diameter and area of the involved blood vessel were measured and the stenotic rate was calculated. Logistic regression analysis was performed to identify the predictors for functional ischemia. The cutoff values of angiographic and IVUS parameters for functional ischemia were identified using ROC curve analysis. Results A total of 116 patients were included, and functional ischemia was identified in 56 patients (48.3%). The independent predictors for functional ischemia were found to be LVEF, LAD disease, reference lumen diameter by QCA and reference lumen cross-sectional area by IVUS. The diagnostic accuracy of reference lumen diameter and reference lumen cross-sectional area was similar (AUC=0.69 and 0.71, respectively). In patients with LAD disease, the diagnostic accuracy of reference lumen cross-sectional area for predicting functional ischemia in LAD was high (AUC=0.74). Conclusions In patients with intermediate coronary artery stenosis, lesion distribution and local structural factors are predictors for functional ischemia. The reference lumen cross-sectional area by IVUS is the most significant predictor for functional ischemia in LAD. Key words: Coronary disease; Tomography, emission-computed, single-photon; Coronary angiography; Ultraound