Intravascular Ultrasound in Patients with Intermediate Left Main Coronary Artery Lesions According to Angiography
Abstract
According to the current guidelines the left main disease with stenosis >50% by coronary angiography (CAG) is the indication for revascularization. However, the limitations of CAG in estimation of left main coronary artery lesions are well known. Purpose. To compare the results of CAG and intravascular ultrasound (IVUS) in patients with angiographically intermediate left main coronary artery lesions (<50%). Material and methods. IVUS was performed in 8 patients with left main coronary artery stenoses <50% by CAG. The measure of agreement of IVUS and CAG was assessed by Cohen's kappa coefficient. Results. The value of Cohen's kappa coefficient was 0.6 (CI -0.072 - 1.272; p = 0.064), which is showing that the results of IVUS and CAG has no agreement in making decision about surgery of left main coronary artery intermediate lesions. Conclusion. In patients with intermediate left main coronary artery lesions decision about coronary stenting should be made only on IVUS data.
About the Authors
Vadim Anatolievich Kuznetsov
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
Elena Ilyinichna Yaroslavskaya
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
Igor Pavlovich Ziryanov
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
Ivan Sergeevich Bessonov
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
Stanislav Stalikovich Sapoznikov
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
Elena Aleksandrovna Gorbatenko
FSBSI “Research Institute of Cardiology”
Russian Federation
Russian Federation
References
1. Lindstaedt M., Spiecker M., Perings C. et al. How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? Int. J. Cardiol 2007; 120: 254-261.
2. Hamilos M., Muller O., Cuisset T. et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation. 2009; 120: 1505-1512.
3. Levine G.N., Bates E.R., Blankenship J.C., et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc. Interv. 2012; 79 (3): 453-495.
4. Isner J.M., Kishel J., Kent K.M. et al. Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic-Histologic correlative analysis in 28 patients. Circulation. 1981; 63: 1056-1065.
5. Иванов В.А., Мовсесянц М.Ю., Трунин И.В. Внутрисосудистые методы исследования в интервенционной кардиологии. М.: Медпрактика; 2008; 212 с.
6. Judkins M.P. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967; 89 (5): 815-824.
7. Schlesinger M.J., Zoll P.M., Wessler S. The conus artery; a third coronary artery. Am. Heart J. 1949; 38 (6): 823-836.
8. Петросян Ю.С., Зингерман Л.С. Коронарография. М.: Медицина, 1974. 151 с.
9. De la Torre Hernandez J.M., Hernandez Hernandez F. Alfonso F. et al. Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study. J. Am. Coll. Cardiol. 2011; 58 (4): 351-358.
10. Talebkhan Y., Mohammadi M., Rakhshani N., et al. Interobserver variations in histopathological assessment of gastric pathology. Pathology. 2009; 41 (5): 428-432.
11. Fihn S.D., Gardin J.M., Abrams J., et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J. Am.Coll. Cardiol. 2012; 60 (24): e44-e164.
12. Демин В.В. Клиническое руководство по внутрисосудистому ультразвуковому исследованию. Оренбург: Южный Урал, 2005. 400 с.
13. Lotfi A., Jeremias A., Fearon W.F. et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the society of cardiovascular angiography and interventions. Catheter Cardiovasc. Interv. 2014; 83 (4): 509-518.
14. Naganuma T., Latib A., Costopoulos C. et al. The role of intravascular ultrasound and quantitative angiography in the functional assessment of intermediate coronary lesions: correlation with fractional flow reserve. Cardiovasc. Revasc. Med. 2014; 15 (1): 3-7.
15. Abizaid A.S., Mintz G.S., Abizaid A. et al. One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms. J. Am. Coll. Cardiol. 1999; 34 (3): 707-715.
16. Мовсесянц М.Ю., Бобков Ю.А., Белякин С.А. с соавт. Внутрисосудистые методы исследования на различных этапах коронарных вмешательств при поражениях ствола ЛКА и бифуркационных поражениях. Тезисы ежегодной научно-практической конференции Российского Научного Общества Интервенционных Кардиологов “Теория и практика современной интервенционной кардиоангиологии”. Международный журнал интервенционной кардиоангиологии. 2009; 19: 47-48.
17. Task Force Members, Montalescot G., Sechtem U., et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur. Heart J. 2013; 34 (38): 2949-3003.
Review
For citations:
Kuznetsov V.A., Yaroslavskaya E.I., Ziryanov I.P., Bessonov I.S., Sapoznikov S.S., Gorbatenko E.A. Intravascular Ultrasound in Patients with Intermediate Left Main Coronary Artery Lesions According to Angiography. Medical Visualization. 2015;(1):48-53. (In Russ.)
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