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ȣ - 550675 146 |
| Two-Year Follow Up Clinical Outcome in Patients with Angiographically Intermediate Lesions with Minimum Lumen Area Less Than 4mm2 using Intravascular Ultrasound in Non-Proximal Epicardial Coronary artery |
| 성가롤로병원 순환기내과¹ , 전남대학교병원 순환기내과² |
| 송진아² , 조장현¹ , 김수현¹ , 최승¹ , 윤명호¹ , 박재영¹ , 홍영준² ,정명호² 최윤하² 김동한² 이기홍² , Futoshi Yamanaka², 이민구² , 박근호² ,심두선² , 윤남식² ,윤현주² ,김계훈² ,박형욱² ,김주한² ,안영근² ,조정관² ,박종춘² ,강정채² |
Background: The cut-off value of intravascular ultrasound (IVUS) minimum lumen area (MLA) 4mm2 is currently used for the prediction of future clinical events in patients with proximal epicardial coronary artery disease. However, data on intermediate lesion with IVUS MLA < 4mm2 in non-intervented non-proximal epicardial coronary artery are lacking.
Methods: We retrospectively enrolled 103 patients with intermediate lesion with IVUS MLA < 4mm2 in non-intervented non-proximal epicardial coronary artery from April, 2003 to August, 2008, and divided the patients into two groups: Group I [MLA < 3mm2 (n=47)]; Group II [MLA = 3-4mm2 (n=56)]. We evaluated the incidences of 2-year clinical event rates (cardiac death, nonfatal myocardial infarction, cerebrovascular accidents, and target lesion and target vessel revascularizations) after medical therapy.
Results: Group I had more unstable anginas (31%) and were more female patients (63%) and the incidences of hypertension and dyslipidemia were 30% and 32%. Group II had more stable anginas (69%) and were male patients (61%), and the incidence of diabetes mellitus was 78%. Group II had higher creatinine and homocysteine levels (0.8±0.1 mg/dl vs. 0.9±0.3 mg/dl, p=0.003 and 7.0±1.7 µmol/L vs. 8.5±3.1 µmol/L, p=0.031). At the minimum lumen site, Group II had greater lumen and plaque plus media area (2.5±0.3 mm2 vs. 3.6±0.3 mm2, p=0.001 and 4.8±1.4 mm2 vs. 6.8±1.8 mm2, p=0.001), had greater calcium arc and longer calcium length (13.9±31.1º vs. 44.5±55.6º, p=0.001 and 0.5±1.2 mm vs. 1.4±1.7 mm, p=0.005). There were no significant differences in 2-year clinical events [cardiac death (0 % vs.5%, p=0.224), nonfatal myocardial infarction (4 % vs.1 %, p=0.440), cerebrovascular accidents (4 % vs.1 %, p=0.440), and target lesion and target vessel revascularizations (7% vs.9%, p=0.776 and 7% vs.11 %, p=0.638] between two groups.
Conclusions: Event rates are relatively low with only medical therapy without any intervention in patients with intermediate lesion with IVUS MLA < 4mm2, so the cut-off of IVUS MLA 4mm2 may not be applied for patients with angiographically intermediate lesions with IVUS MLA 4mm2 in non-proximal epicardial coronary artery.
Key Words: Coronary artery disease, Clinical outcome, Intravascular Ultrasound
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