Use of Intracoronary Ultrasound Image for Assessing Left Main Coronary Artery Disease

Abstract

The aim of the study was to estimate the effeotiveness of an intravascular ultrasound (IVUS)-guided manipulation for patients with angiographically indeterminate left main coronary artery (LMCA) disease. The evaluation of LMCA lesions using coronary angiography is after challenging; P/US supply efficient information for assessment of left main coronary artery disease. IVUS was performed on 46 patients with angographically normal minimum lumen area (MLA), defined as the mean -2SD. We conducted IVUS studies on 24 patients with angiographically indeterminate left main coronary artery lesions, and deferral of revascularization was recommended when the MLA was larger than this predetermined valve. The lower range of normal LMCA MLA was 6.5mm^2 Of the patients with angiographically indeterminate LMCA 9 (37.5%) had an MLA＜6.5mm^2, and 15 (62.5%) an MLA≧6.5mm^2. LMCA revascularization was performed in 77.7% (7 of 9) of patients with an WLA＜65mm^2, and deferred in 86.6% (13 of 15) of patients with an MLA≧6.5mm^2 Long-term follow-up (1.3±2.0 years) showed no significant difference major adverse cardiac events (target vessel revascularization, acute myocardial infarction, and death) between patients with an MLA＜6.5mm^2 who underwent revascularization and those with an MLA≧6.5mm^2 deferred for revascularization. Based on outcome the best cut-off MLA by receiver operating characteristic was 8.4mm^2. Major risk factors of cardiac events were age, smoking, and number of non-LMCA vessels disease. IVUS is an accurate method to assess angiographically indeterminate lesions of the LMCA. Furthermore, deferring revascularization for patients with a minimum lumen area≧6.5mm^2 appears to be safe