The usefulness of intracoronary ultrasound in the treatment decision-making of patients with ambiguous lesions in the left main coronary artery.
OBJECTIVE
To evaluate the safety and efficacy of surgical treatment approach vs. conservative approach in patients with ambiguous lesions in the left main coronary artery (LMCA), based on intracoronary ultrasound (ICUS) findings.


METHODS
Sixty-six consecutive patients with angiographically ambiguous lesions were included and submitted to ICUS assessment. They were divided in two groups, according to the ICUS findings. Group I was maintained under clinical treatment [minimal lumen area (MLA) > 6.0 mm(2) and/or minimal lumen diameter (MLD) > 2.5 mm] and Group II was submitted to revascularization (MLA < 6.0 mm(2) and/or MLD < 2.5 mm). The occurrence of major cardiac events (death, acute myocardial infarction and/or revascularization of the target lesion) was assessed during follow-up.


RESULTS
Forty-one (62%) patients were allocated in Group I and 25 (38%) in Group II. Mean follow-up was 42.1 months. The coronary angiography did not differentiate the two groups regarding lesion severity (MLD 1.98 mm in Group I vs. 1.72 mm in Group II; p = 0.75) in opposition to ICUS (MLD 3.41 mm in Group I vs. 2.01 mm in Group II; p < 0.001). There was no death or myocardial infarction in Group I. The survival rate free of major cardiac events was 95% in Group I vs. 87.5% in Group II (p=ns).


CONCLUSIONS
Treatment decision-making of patients with ambiguous lesions in the LMCA guided by ICUS findings showed to be safe and effective.
Vaz
Vinicius Daher
VD
Instituto Dante Pazzanese de Cardiologia, São Paulo, SP.
Abizaid
Andrea Claudia Leão de Souza
AC
Abizaid
Alexandre Antonio Cunha
AA
Feres
Fausto
F
Staico
Rodolfo
R
Mattos
Luiz Alberto Piva
LA
Pinto
Ibraim
I
Tanajura
Luiz Fernando Leite
LF
Sousa
Amanda G M R
AG
Sousa
José Eduardo M R
JE
D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D003657:Decision Making; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects