Arquivos Brasileiros de Cardiologia (Dec 2004)

O uso do ultra-som intracoronariano na tomada de decisão para o tratamento das lesões coronarianas moderadas The use of intravascular ultrasound in deciding on the treatment of moderate coronary lesions

  • Andrea Claudia Leão de Sousa Abizaid,
  • Leopoldo Soares Piegas,
  • Alexandre Antonio Cunha Abizaid,
  • Luiz Fernando Leite Tanajura,
  • Aurea Jacob Chaves,
  • Marinella Patrizia Centemero,
  • Ana Cristina C. Seixas,
  • Luiz Alberto Piva Mattos,
  • Ibraim Pinto,
  • Amanda Guerra Morais Rego Sousa,
  • J. Eduardo Morais Rego Sousa

DOI
https://doi.org/10.1590/S0066-782X2004001900002
Journal volume & issue
Vol. 83, no. spe
pp. 3 – 6

Abstract

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OBJETIVO: Investigar o critério ultra-sonográfico de área mínima da luz (AML), com valor de corte igual a 4,0 mm² na tentativa de diferençar as lesões que devem ou não ser tratadas. MÉTODOS: Incluímos 173 pacientes consecutivos com lesões angiograficamente moderadas (porcentual de estenose entre 40 e 70) submetidos à realização de ultra-som, divididos em 2 grupos: grupo 1 clínico (AML > 4,0 mm²) e grupo 2 revascularização (AML 4,0 mm² 75 (43%) pacientes, mantidos clinicamente e 98 (57%) pacientes AML OBJECTIVE: To investigate the ultrasound criterion of minimum luminal area (MLA) with a cutoff value of 4.0 mm² in an attempt to differentiate the lesions that should be treated from those that should not. METHODS: The study comprised 173 consecutive patients with moderate angiographic lesions (percentage of stenosis between 40 and 70) who underwent ultrasound imaging. They were divided into 2 groups as follows: group 1 or clinical group (MLA > 4.0 mm²); and group 2 or revascularization group (MLA 4.0 mm² and were clinically treated; 98 (57%) patients had MLA < 4.0 mm² and were treated with coronary stents. On quantitative coronary angiography, no significant difference was observed between the percentage of vessel stenosis [group 1: 48% vs group 2: 53%; P=0.06]. By the other hard ultrasound measurements, as MLA was significantly greater in group 1 compared with that in group 2 [4.54 mm² vs 2.45 mm²; P < 0.001)]. The clinical impact of the decision was favorable, and no difference was observed in regard to the occurrence of major cardiac events: [group 1: 5 (7%) vs group 2: 14 (15%); P = 0.09]. The need for revascularization of the target lesion also did not differ (group 1: 3 (4%) vs group 2: 11 (12%); P = 0.07). The predictive variables for MCE were diabetes, functional class III (FC III) angina before hospitalization, and MLA assessed on ultrasound. CONCLUSION: This strategy for deciding on appropriate treatment guarantees low rates of MCE in both groups in the 24-month follow-up, with reduced revascularization rates. The predictive variables of major cardiac events were as follows: diabetes mellitus, FC III angina, and MLA on intravascular ultrasound.

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