Prospective Application of Pre-Defined Intravascular Ultrasound Criteria for Assessment of Intermediate Left Main Coronary Artery Lesions: Results From the Multicenter LITRO Study

Aug 19, 2011
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Authors:
de la Torre Hernandez JM, Hernández Hernandez F, Alfonso F, et al.; on behalf of the LITRO Study Group (Spanish Working Group on Interventional Cardiology).
Citation:
J Am Coll Cardiol 2011;58:351-358.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the clinical impact of using 6 mm2 as a minimum lumen area (MLA) cutoff value for revascularization of left main coronary artery (LMCA) lesions?

Methods:

The authors reported the outcome of 354 patients who underwent intravascular ultrasound (IVUS) for assessment of LMT stenosis at 22 Spanish centers. Revascularization was recommended in patients with a LMT MLA of <6 mm2.

Results:

LMCA revascularization was performed in 90% (152 of 168) of patients with an MLA <6 mm2 and was deferred in 96% (179 of 186) of patients with an MLA >6 mm2 . There was significant variability between the two groups with respect to angiographic stenosis severity. There was no difference in the survival free of cardiac death at 2 years between the two groups (97.7% in the deferred group vs. 94.5% in the revascularized group, p = 0.5), or event-free survival ( 87.3% vs. 80.6%, p = 0.3). Among patients in the deferred group, only 8 (4.4%) patients required subsequent revascularization over a 2-year follow-up period. In 43% of patients with a LMCA stenosis of 50-60%, the LMCA MLA was > 6 mm2.

Conclusions:

An MLA of 6 mm2 or more is a safe value for deferring revascularization of the LMCA.

Perspective:

Angiographic assessment is unreliable for assessing the clinical implications of intermediate LMCA stenosis, and IVUS is commonly used for this purpose. This study provides a real-word multicenter validation of using the 6 mm2 MLA as the criterion to define need for revascularization in patients with LMCA stenosis.

Keywords: Follow-Up Studies, Coronary Stenosis, Cardiology, Coronary Vessels, Hispanic Americans


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