Document Detail


Threshold parameters of left main coronary artery stem stenosis based on intracoronary ultrasound examination.
MedLine Citation:
PMID:  16180175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The left main coronary stem (LMS) provides blood supply to the left ventricle, and its stenosis is associated with serious clinical consequences. The accurate assessment of LMS stenosis determines appropriate treatment and long term prognosis. So far no criteria have been established to correctly estimate the magnitude of problematic lesions as indicated by quantitative angiography (QCA). AIM: An attempt to establish intracoronary ultrasound (ICUS) threshold values of significant LMS stenosis. METHODS: The studied group consisted of 197 patients (mean age 69.72+/-8.51) who underwent percutaneous coronary intervention (PCI) of the left coronary artery. Group 1 (G1) consisted of 99 patients who had LMS diameter reduction (%DS) of less than 30%. Group 2 (G2) consisted of 77 patients with %DS between 30% and 50%, and the remaining 21 patients with %DS higher than 50% were classified as Group 3 (G3). The quantitative angiography (QCA) analysis included lumen diameter (Ldmin) which was LMS lumen diameter at the most stenotic segment as well as LMS diameter reduction (%DS). The parameters that were analysed during ICUS study included maximum plaque burden (%) (Pbmax), minimal lumen area (LAmin) and lumen stenosis (%LS) calculated according to the formula: (LAmin/LAref) x 100%. Additionally, correlations between the corresponding parameters measured using QCA and ICUS were investigated. RESULTS: Both diagnostic techniques showed the most advanced degree of atherosclerosis in G3. All the G3 patients and 5 G2 patients had MLD values less than or equal to 2 mm. In G1 LAmin values exceeded 9 mm(2) in all patients, whereas among G2 patients 12 (15.5%) had LAmin lower than 6 mm(2), 29 pts. (37.66%) within the range of 6-9 mm(2) and in the remaining 36 pts. (46.75%) it exceeded 9 mm(2). In G3 LAmin values in 17 pts. (80.95%) did not exceed 6 mm(2) and in the remaining 4 pts. (19.05%) were slightly higher. Lumen reduction higher than 50% was noted in all G3 patients and 3 G2 patients (in all these 3 G2 patients LAmin values were lower than 6 mm(2)). All G3 pts. and 3 G2 pts. with LAmin value <6 mm(2) and %LS >50% had angina and a positive stress ECG test. All of these patients (n=24) underwent LMS stent implantation. CONCLUSIONS: 1. Minimal lumen diameter of LMS < or = 2 mm in quantitative angiography indicates a very high probability of significant stenosis of this vessel. 2. Ultrasound data analysis shows that besides LMS lumen area (<9 mm(2)) stenosis significance is determined by lumen reduction of more than 50%.
Authors:
Robert J Gil; Aneta I Gziut; Francesco Prati; Adam Witkowski; Jacek Kubica
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Kardiologia polska     Volume:  63     ISSN:  0022-9032     ISO Abbreviation:  Kardiol Pol     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-23     Completed Date:  2006-03-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376352     Medline TA:  Kardiol Pol     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  223-31; discussion 232-3     Citation Subset:  IM    
Affiliation:
Department of Invasive Cardiology, Central Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland. kardiologia.inwazyjna@cskmswia.pl
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Catheter Ablation
Coronary Angiography*
Coronary Artery Disease / radiography,  ultrasonography
Coronary Circulation
Coronary Stenosis / radiography*,  therapy,  ultrasonography*
Coronary Vessels
Female
Humans
Linear Models
Male
Middle Aged
Retrospective Studies
Ultrasonography, Interventional*

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