Abstract 18028: Optimal Intravascular Ultrasound Criteria and Their Accuracy for Defining the Functional Significance of Intermediate Coronary Stenoses: Results from International Multi-center Study
Background Even though intravascular ultrasound (IVUS) provides anatomic information, there were no consistent IVUS cut-off values for predict functional significance of coronary artery stenosis.
Method A total of 1,032 lesions with available IVUS and fractional flow reserve (FFR) were recruited from 11 international centers and 881 de novo lesions with intermediate stenosis located at the non-left main major epicardial coronary arteries (822 patients, male 70.6%) were included in this analysis. All data were analyzed at Seoul National University Data Management Core Laboratory. FFR ≤0.8 was considered functionally significant.
Results Mean FFR was 0.81±0.11 and 353 lesions (40.1%) were functionally significant. The diagnostic accuracy of minimum luminal area (MLA) was highly variable according to the location of lesions. The best cut off value of MLA to define the functional significance was 3.0 mm2 (area under the curve [AUC]: 0.73, 95% confidence interval [CI]: 0.67 to 0.79) for proximal left anterior descending artery (LAD) lesions with sensitivity 70%, specificity 60%, positive predictive value (PPV) 64% and negative predictive value (NPV) 72%. In mid LAD, the best cut off value of MLA was 2.75 mm2 (AUC: 0.67, 95% CI: 0.60-0.73) with sensitivity 62%, specificity 70%, PPV 63% and NPV 69%. However, the appropriate MLA to predict the functional significance of lesions could not be found in other segments.
Conclusion When IVUS parameters are used to determine the functional significance of lesions in patients with intermediate coronary artery stenosis, different criteria should be used according to lesion location.
- © 2012 by American Heart Association, Inc.