title: Remodeling is a more important determinant of lumen size than atheroma burden in left main coronary artery disease.
abstract: 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.
authors.affiliation: Department of Medicine, Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Stéphane
authors.initials: S
authors.lastname: Noble
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Jean
authors.initials: J
authors.lastname: Grégoire
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Philippe L
authors.initials: PL
authors.lastname: L'allier
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
mesh_terms: 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