Impact of remodeling on cardiac events in patients with angiographically mild left main coronary artery disease.
BACKGROUND
The clinical significance of intravascular ultrasound (IVUS) assessed remodeling in left main coronary artery (LMCA) lesions has not been studied. Thus, we evaluated the impact of coronary arterial remodeling on cardiac events in patients with angiographically mild LMCA disease.


METHODS
Two hundred thirty-six patients who underwent IVUS evaluation to determine the severity of angiographically mild LMCA lesions (diameter stenosis < 50%) were included. Negative remodeling (NR) was defined as a remodeling index (lesion/reference external elastic membrane crosssectional 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 patients (156/236). NR lesions were more proximal in location (45.6% vs. 25.0%; p = 0.003), 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) than IR/PR lesions. At 1-year follow up, LMCA-related cardiac events occurred in 15 patients (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, plaque burden was larger, and the remodeling index was greater than in lesions not associated with cardiac events, but only non-NR was an independent predictor of LMCA-related events in patients with mild LMCA disease (hazard ratio 4.095; 95% CI, 1.275-13.149; p = 0.018).


CONCLUSIONS
Angiographically mild LMCA disease was more frequently associated with NR, and NR was associated with fewer LMCA-related cardiac events in patients with mild LMCA lesions.
Hong
Young Joon
YJ
Washington Hospital Center, 100 Irving Street, N.W., Suite EB 5123, Washington, D.C., 20010, USA.
Mintz
Gary S
GS
Kim
Sang-Wook
SW
Lu
Li
L
Bui
Anh B
AB
Pichard
Augusto D
AD
Satler
Lowell F
LF
Waksman
Ron
R
Kent
Kenneth M
KM
Suddath
William O
WO
Weissman
Neil J
NJ
D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional