Optimal intravascular ultrasound criteria for defining the functional significance of intermediate coronary stenosis: an international multicenter study.
OBJECTIVE
We aimed to assess the ideal cut-off value of minimal lumen area (MLA) by intravascular ultrasound (IVUS) and its diagnostic performance to predict ischemia, using a large-scale, pooled analysis.


METHODS
Eleven centers worldwide were invited to provide their clinical, IVUS and fractional flow reserve (FFR) data. A total of 881 lesions were enrolled.


RESULTS
Angiographic % diameter stenosis (r = -0.373, p < 0.0001) and IVUS MLA (r = 0.289, p < 0.0001) correlated with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR <0.8) was 2.75 mm(2) (AUC 0.646, 95% CI 0.609-0.684). When the diagnostic performance of IVUS MLA was tested according to the lesion location, BCV could be found only in lesions in the proximal artery and the mid-left anterior descending artery. Interestingly, Asians (n = 623) and Westerners (n = 258) showed different demographic and lesion characteristics as well as different BCVs to define ischemia. The BCV for the proximal/mid-left anterior descending artery lesions was 2.75 mm(2) (AUC 0.688, 95% CI 0.635-0.742) in Asians and 3.0 mm(2) (AUC 0.695, 95% CI 0.605-0.786) in Westerners.


CONCLUSIONS
In this pooled analysis, an IVUS MLA of 2.75 mm(2) was the BCV to define the functional significance of intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion and patient characteristics should be considered.
Seoul National University Hospital, Seoul, Korea.
Jung-Kyu
JK
Han
Bon-Kwon
BK
Koo
Kyung-Woo
KW
Park
Itsik
I
Ben-Dor
Ron
R
Waksman
Augusto
A
Pichard
Chang-Wook
CW
Nam
Joon-Hyung
JH
Doh
Naotaka
N
Murata
Nobuhiro
N
Tanaka
Chi-Hang
CH
Lee
Nieves
N
Gonzalo
Javier
J
Escaned
Marco A
MA
Costa
Takashi
T
Kubo
Takashi
T
Akasaka
Xinyang
X
Hu
Jianan
J
Wang
Hyoung-Mo
HM
Yang
Myung-Ho
MH
Yoon
Seung-Jea
SJ
Tahk
Seunghyun
S
Ma
Sue K
SK
Park
Hyo-Soo
HS
Kim
D000368:Aged; D044466:Asian People; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D012042:Registries; D018084:Ultrasonography, Interventional / Q000592:standards*; D044465:White People