title: Five-year outcomes of moderate or ambiguous left main coronary artery disease and the intravascular ultrasound predictors of events.
abstract: The long-term outcome of a moderately diseased left main coronary artery (LMCA) remains unknown. One hundred and fourteen patients who underwent angiographic and intravascular ultrasound (IVUS) evaluation for moderate LMCA disease (< 50% diameter stenosis) without intervention were followed for 5 years. There were 11 patients who underwent coronary artery bypass graft surgery (CABG) within 30 days of IVUS analysis based on IVUS findings and 3 patients who died of noncardiac diseases during the follow-up period. These 14 patients were excluded from the cohort, and 100 patients comprised the study group. Six patients (6%) died (1 of cardiac causes and 5 of unknown causes) at a follow up of 31.5 +/- 17.0 months post-IVUS assessment. Two patients (2%) underwent CABG at a follow up of 19.0 +/- 7.1 months. There were no percutaneous LMCA interventions and no myocardial infarctions. Univariate predictors for events were age, mean plaque and media (P&M) area and plaque burden over the entire length of the LMCA lesion, and minimum luminal area (MLA), P&M area, plaque burden, and arc of calcium > 90 degrees at the MLA site. By multiple logistic regression analysis, plaque burden at the MLA (odds ratio = 1.34, 95% confidence interval 1.04-1.73; p = 0.025) was the only independent predictor of events. In conclusion, moderately diseased LMCAs had a 5- year event rate of 8%. The occurrence of future events in moderate diseased LMCAs is dependent on the amount of disease at the MLA site.
authors.affiliation: Cardiovascular Research Institute / MedStar Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Sun Yun
authors.initials: SY
authors.lastname: Lee
authors.forename: Bongryeol
authors.initials: B
authors.lastname: Lee
authors.forename: Probol
authors.initials: P
authors.lastname: Roy
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Tina
authors.initials: T
authors.lastname: Pinto-Slottow
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Smith
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional