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

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?


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.


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.


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


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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