Author(s): de la Torre Hernandez JM, Hernndez Hernandez F, Alfonso F, Rumoroso JR, LopezPalop R,
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Abstract OBJECTIVES: This study is a prospective validation of 6 mm(2) as a minimum lumen area (MLA) cutoff value for revascularization of left main coronary artery (LMCA) lesions. BACKGROUND: Lesions involving the LMCA are prognostically relevant. Angiography has important limitations in the evaluation of LMCA lesions with intermediate severity. An MLA of 6 mm(2) assessed by intravascular ultrasound has been proposed as a cutoff value to determine lesion severity, but there are no large studies evaluating the prospective application and safety of this approach. METHODS: We have designed a multicenter, prospective study. Consecutive patients with intermediate lesions in unprotected LMCA were evaluated with intravascular ultrasound. An MLA <6 mm(2) was used as criterion for revascularization. RESULTS: A total of 354 patients were included in 22 centers. LMCA revascularization was performed in 90.5\% (152 of 168) of patients with an MLA <6 mm(2) and was deferred in 96\% (179 of 186) of patients with an MLA of 6 mm(2) or more. A large scatter was observed between both groups regarding angiographic parameters. In a 2-year follow-up period, cardiac death-free survival was 97.7\% in the deferred group versus 94.5\% in the revascularized group (p = 0.5), and event-free survival was 87.3\% versus 80.6\%, respectively (p = 0.3). In the 2-year period, only 8 (4.4\%) patients in the deferred group required subsequent LMCA revascularization, none with an infarction. CONCLUSIONS: Angiographic measurements are not reliable in the assessment of intermediate LMCA lesions. An MLA of 6 mm(2) or more is a safe value for deferring revascularization of the LMCA, given the application of the clinical and angiographic inclusion criteria used in this study. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
This article was published in J Am Coll Cardiol
and referenced in Journal of Cardiovascular Diseases & Diagnosis