Abstract 1975: Impact of Remodeling on Cardiac Events in Patients with Angiographically Mild Left Main Coronary Artery Disease
The clinical significance of intravascular ultrasound (IVUS) assessed remodeling in left main coronary artery (LMCA) lesions has not been studied.
Methods: We evaluated the impact of coronary arterial remodeling on cardiac events in 236 pts with angiographically mild LMCA disease (diameter stenosis < 50%). Negative remodeling (NR) was defined as remodeling index (lesion/reference external elastic membrance cross-sectional area [CSA]) < 0.95, intermediate remodeling (IR) as between 0.95–1.05, and positive remodeling (PR) as > 1.05.
Results: NR was observed in two-thirds of pts (156/236). NR lesions were less frequently associated with soft plaque morphology (23.1% vs. 43.8%, p < 0.001), and had smaller plaque burdens (34.0 ± 12.0 vs. 40.3 ± 10.7%, p = 0.001) but similar lumen dimensions compared to IR/PR lesions. At 1-year follow-up, LMCA-related major adverse cardiac events occurred in 15 pts (6.3%). NR was less frequently associated with LMCA-related cardiac events than IR/PR [6/156 (3.8%) vs. 9/80 (11.3%), p = 0.027]. In lesions associated with LMCA-related events, lumen CSA was smaller (8.8 ± 1.5 vs. 12.9 ± 3.7mm2, p < 0.001), plaque burden was larger (47.1 ± 11.4 vs. 35.4 ± 11.6%, p = 0.001), and remodeling index was greater (0.97 ± 0.08 vs. 0.90 ± 0.11, p = 0.004) than in lesions not associated with cardiac events, but only non-NR was an independent predictor of LMCA-related events in pts with mild LMCA disease (Hazard ratio; 4.095, 95% CI; 1.275–13.149, p = 0.018, Figure⇓).
Conclusions: Angiographically mild LMCA disease was more frequently associated with NR, and NR was associated with fewer LMCA-related cardiac events in pts with mild LMCA lesions.