1146, either, cat: 12
QUANTITATIVE CORONARY ANGIOGRAPHY (QCA) OF
INDETERMINATE LEFT MAIN DISEASE CAN RELIABLY PREDICT
SEVERITY
C.L. Laham1, M.S. Chandra1, M.J. McMahon1, R. Venzon1, M. Jerin2,
N.W. Shammas2
1
St. Luke’s Hospital, Cedar Rapids, IA, 2Midwest Cardiovascular Research
Foundation, Davenport, IA, USA
Background: Left main coronary lesions are considered severe if they have a
minimum luminal area (MLA) of ≤5.9 mm2 by intracoronary ultrasound (IVUS).
Based on Area stenosis= ∏ x (radius)2, MLA≤ 5.9 mm2 corresponds to a lesion
minimum luminal diameter (MLD) of ≤2.74 mm. Given eccentricity of lesions, a
single view angiographic assessment of disease severity is unreliable.
Objective: We hypothesized, that applying 2-view QCA to symptomatic patients with
indeterminate LM and large artery lesions using the conservative average of MLD
≤2.66 mm as cutoff marker, would predict MLA<5.9 mm2 by IVUS.
Methods/Results: We evaluated 119 symptomatic indeterminate large artery lesions of
which 47 were in LM’s (average vessel sizes and standard deviations 5.34 +/0.123mm and 6.22+/-0.965 respectively). There was a very strong correlation between
mean angiographic 2-view lesion MLD and IVUS determined MLA using Pearson’s
correlations, r = 0.822 (0.855 in true left mains, both p < 0.001). The positive
predictive value of 2-view QCA overall (and in true left mains) was 98% (95%) with
negative predictive value of 86% (85%).
Figure. Lesion MLA (IVUS) vs MLD (QCA)
12
Lesion MLA (mm2)
10
8
6
4
2
0
0.0
.5
1.0
1.5
2.0
2.5
3.0
3.5
Average MLD by QCA (mm)
Conclusion: Average lesion MLD ≤2.66 mm by QCA in 2 orthogonal angiographic
views is a strong predictor of MLA<5.9 mm2 by IVUS, suggesting that this method
can reliably identify severe LM lesions in symptomatic patients with angiographically
indeterminate LM disease.