Arquivos Brasileiros de Cardiologia (Dec 2006)

Utilidade do ultra-som intracoronariano na decisão do tratamento de pacientes com lesões duvidosas no tronco da coronária esquerda The usefulness of intracoronary ultrasound in the treatment decision-making of patients with ambiguous lesions in the left main coronary artery

  • Vinicius Daher Vaz,
  • Andrea Claudia Leão de Souza Abizaid,
  • Alexandre Antonio Cunha Abizaid,
  • Fausto Feres,
  • Rodolfo Staico,
  • Luiz Alberto Piva Mattos,
  • Ibraim Pinto,
  • Luiz Fernando Leite Tanajura,
  • Amanda G. M. R. Sousa,
  • José Eduardo M. R. Sousa

DOI
https://doi.org/10.1590/S0066-782X2006001900001
Journal volume & issue
Vol. 87, no. 6
pp. 681 – 687

Abstract

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OBJETIVO: Avaliar a segurança e eficácia da estratégia de tratamento cirúrgico ou conservador em pacientes com de lesões duvidosas de tronco da coronária esquerda (TCE), baseada nos achados do ultra-som intracoronariano (USIC). MÉTODOS: Incluídos 66 pacientes consecutivos com lesões angiograficamente duvidosas no TCE submetidos a avaliação ao USIC. Foram divididos em dois grupos de acordo com os achados do USIC. Grupo I, mantidos em tratamento clínico [área mínima da luz (AML) > 6,0 mm² e/ou diâmetro mínimo da luz (DML) > 2,5 mm] e Grupo II, encaminhados a revascularização (AML OBJECTIVE: To evaluate the safety and efficacy of surgical treatment approach vs. conservative approach in patients with ambiguous lesions in the left main coronary artery (LMCA), based on intracoronary ultrasound (ICUS) findings. METHODS: Sixty-six consecutive patients with angiographically ambiguous lesions were included and submitted to ICUS assessment. They were divided in two groups, according to the ICUS findings. Group I was maintained under clinical treatment [minimal lumen area (MLA) > 6.0 mm² and/or minimal lumen diameter (MLD) > 2.5 mm] and Group II was submitted to revascularization (MLA < 6.0 mm² and/or MLD < 2.5 mm). The occurrence of major cardiac events (death, acute myocardial infarction and/or revascularization of the target lesion) was assessed during follow-up. RESULTS: Forty-one (62%) patients were allocated in Group I and 25 (38%) in Group II. Mean follow-up was 42.1 months. The coronary angiography did not differentiate the two groups regarding lesion severity (MLD 1.98 mm in Group I vs. 1.72 mm in Group II; p = 0.75) in opposition to ICUS (MLD 3.41 mm in Group I vs. 2.01 mm in Group II; p < 0.001). There was no death or myocardial infarction in Group I. The survival rate free of major cardiac events was 95% in Group I vs. 87.5% in Group II (p=ns). CONCLUSION: Treatment decision-making of patients with ambiguous lesions in the LMCA guided by ICUS findings showed to be safe and effective.

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