Remodeling is a more important determinant of lumen size than atheroma burden in left main coronary artery disease.
BACKGROUND
Left main coronary artery (LMCA) disease influences survival; however, the predictors of LMCA changes over time are incompletely understood.


METHODS
Paired intravascular ultrasound (IVUS) and core laboratory analyses were performed in a standardized fashion in 207 subjects (mean +/- SD age 58 +/- 10 years, 80% men). The average follow-up duration was 18 months (range 12-24 months). The IVUS measurements were first obtained at the smallest lumen area and the largest plaque area at follow-up and the corresponding positions in the LMCA were then measured at baseline.


RESULTS
The LMCA percentage of atheroma area at baseline was 38.2% +/- 11.8%, and 133 patients (64%) experienced an increase in percentage of atheroma area. Change in lumen area correlated positively with change in total vessel area (R = 0.85, P < .0001) and negatively with change in percentage of atheroma area (R = -0.58, P < .0001). Change in plaque area correlated well with change in total vessel area (R = 0.64, P < .0001) but only weakly with change in lumen area (r = 0.14, P = .039). Although LMCA length correlated negatively with baseline lumen area and total vessel area, it did not correlate with their changes over time. On multivariable analyses, current smoking predicted an increase in percentage of atheroma area (P = .0013) and plaque area (P = .0041). Height negatively predicted change in percentage of atheroma area (P = .001).


CONCLUSIONS
The LMCA lumen dimensions are more tightly linked with remodeling than with atheroma progression/regression.
Berry
Colin
C
Department of Medicine, Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada.
Noble
Stéphane
S
Ibrahim
Reda
R
Grégoire
Jean
J
Levesque
Sylvie
S
L'allier
Philippe L
PL
Tardif
Jean-Claude
JC
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D013997:Time Factors; D018084:Ultrasonography, Interventional