(Circulation. 1999;100:256-261.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Follow-Up After Percutaneous Transluminal Coronary Angioplasty Was Not Performed Based on Intravascular Ultrasound Findings
Importance of Lumen Dimensions
From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, the Washington Hospital Center, Washington DC.
Correspondence to Gary S. Mintz, MD, Director, Coronary Ultrasound Program, Washington Hospital Center, 110 Irving Street Suite 4B-1, Washington, DC 20010.
Background—Angiography is limited in determining the anatomic severity of coronary artery stenoses. Clinical decision-making in patients with symptoms and intermediate lesions remains challenging.
Methods and Results—The current analysis included 300
patients (357 intermediate native artery lesions) in whom intervention
was deferred based on intravascular ultrasound (IVUS) findings.
Standard clinical, angiographic, and IVUS parameters were
collected. Patients were followed for >1 year. Events occurred in 24
patients (8%). They included 2 cardiac deaths, 4 myocardial
infarctions, and 18 target-lesion
revascularizations (TLR; 12
percutaneous transluminal coronary
angiographies and 6 coronary artery bypass grafts; only 3 TLRs
occurred within 6 months after the IVUS study). All significant
univariate clinical, angiographic, and IVUS
parameters (P<0.05) were tested in
multivariate models. These included diabetes mellitus,
IVUS lesion lumen area, maximum lumen diameter, minimum lumen diameter,
plaque area, plaque burden, and area stenosis (AS). 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—Long-term follow-up after IVUS-guided deferred
interventions in patients with de novo intermediate native artery
lesions showed a low event rate. In patients with a minimum lumen area
4.0 mm2, the event rate was especially low. IVUS
imaging is an acceptable alternative to
physiological assessment in these patients.
Key Words: lesion • ultrasonography, interventional • coronary disease
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