Prospective Application of Pre-Defined Intravascular Ultrasound Criteria for Assessment of Intermediate Left Main Coronary Artery Lesions Results From the Multicenter LITRO Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

de la Torre Hernandez, Jose M.¹  Hernandez Hernandez, Felipe²  Alfonso, Fernando³  Rumoroso, Jose R.⁴  Lopez-Palop, Ramon⁵  Sadaba, Mario³  Carrillo, Pilar⁴  Rondan, Juan⁶  Lozano, Inigo⁶  Ruiz Nodar, Juan M.⁷  Baz, Jose A.⁸  Fernandez Nofrerias, Eduard⁹  Pajin, Fernando¹⁰  Garcia Camarero, Tamara¹  Gutierrez, Hipolito¹¹ 

[1] IFIMAV, Hosp Marques de Valdecilla, Santander, Spain

[2] Hosp 12 Octubre, E-28041 Madrid, Spain

[3] Hosp Clin San Carlos, Madrid, Spain

[4] Hosp Galdakano, Bilbao, Spain

[5] Hosp San Juan, Alicante, Spain

[6] Univ Oviedo, Hosp Cent Asturias, E-33080 Oviedo, Spain

[7] Gen Hosp, Alicante, Spain

[8] H Meixoeiro, Vigo, Spain

[9] H Germans Trias & Pujol, Barcelona, Spain

[10] H Virgen de la Salud, Toledo, Spain

[11] H Clin Valladolid, Valladolid, Spain

关键词: coronary artery disease;    intravascular ultrasound;    ischemia;    left main coronary artery;    stenosis;   

DOI  :  10.1016/j.jacc.2011.02.064

来源: Elsevier

【 摘 要 】

Objectives This study is a prospective validation of 6 mm(2) as a minimum lumen area (MLA) cutoff value for revascularization of left main coronary artery (LMCA) lesions. Background Lesions involving the LMCA are prognostically relevant. Angiography has important limitations in the evaluation of LMCA lesions with intermediate severity. An MLA of 6 mm(2) assessed by intravascular ultrasound has been proposed as a cutoff value to determine lesion severity, but there are no large studies evaluating the prospective application and safety of this approach. Methods We have designed a multicenter, prospective study. Consecutive patients with intermediate lesions in unprotected LMCA were evaluated with intravascular ultrasound. An MLA <6 mm(2) was used as criterion for revascularization. Results A total of 354 patients were included in 22 centers. LMCA revascularization was performed in 90.5% (152 of 168) of patients with an MLA <6 mm(2) and was deferred in 96% (179 of 186) of patients with an MLA of 6 mm(2) or more. A large scatter was observed between both groups regarding angiographic parameters. In a 2-year follow-up period, cardiac death-free survival was 97.7% in the deferred group versus 94.5% in the revascularized group (p = 0.5), and event-free survival was 87.3% versus 80.6%, respectively (p = 0.3). In the 2-year period, only 8 (4.4%) patients in the deferred group required subsequent LMCA revascularization, none with an infarction. Conclusions Angiographic measurements are not reliable in the assessment of intermediate LMCA lesions. An MLA of 6 mm(2) or more is a safe value for deferring revascularization of the LMCA, given the application of the clinical and angiographic inclusion criteria used in this study. (J Am Coll Cardiol 2011;58:351-8) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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