Comparison of Intravascular Ultrasound to Contrast-Enhanced 64-Slice Computed Tomography to Assess the Significance of Angiographically Ambiguous Coronary Narrowings

Okabe, Teruo; Weigold, Wm. Guy; Mintz, Gary S.; Roswell, Robert; Joshi, Subodh; Lee, Sung Yun; Lee, Bongryeol; Steinberg, Daniel H.; Roy, Probal; Pinto Slottow, Tina L.; Smith, Kimberly; Torguson, Rebecca; Xue, Zhenyi; Satler, Lowell F.; Kent, Kenneth M.; Pichard, Augusto D.; Weissman, Neil J.; Lindsay, Joseph; Waksman, Ron

doi:10.1016/j.amjcard.2008.05.066

« Previous Next »American Journal of Cardiology
Volume 102, Issue 8 , Pages 994-1001, 15 October 2008

Comparison of Intravascular Ultrasound to Contrast-Enhanced 64-Slice Computed Tomography to Assess the Significance of Angiographically Ambiguous Coronary Narrowings

Teruo Okabe, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Wm. Guy Weigold, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Gary S. Mintz, MD
- Cardiovascular Research Foundation, Washington, DC
Robert Roswell, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Subodh Joshi, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Sung Yun Lee, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Bongryeol Lee, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Daniel H. Steinberg, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Probal Roy, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Tina L. Pinto Slottow, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Kimberly Smith, BS
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Rebecca Torguson, MPH
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Zhenyi Xue, MS
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Lowell F. Satler, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Kenneth M. Kent, MD, PhD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Augusto D. Pichard, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Neil J. Weissman, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Joseph Lindsay, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
Ron Waksman, MD
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
- Corresponding author: Tel: 202-877-2812; fax: 202-877-2715

Received 19 March 2008; received in revised form 27 May 2008; accepted 27 May 2008. published online 04 August 2008.

The efficacy of contrast-enhanced multislice computed tomography (MSCT) for assessment of ambiguous lesions is unknown. We compared both quantitative coronary angiography (QCA) and MSCT to the gold standard for a significant stenosis—minimum luminal area (MLA) by intravascular ultrasound (IVUS)—in 51 patients (64 ± 10 years old, 19 men) with 69 angiographically ambiguous, nonleft main lesions. The MSCT was performed 17 ± 18 days before IVUS analysis. Overall diameter stenosis by QCAwas 51.0 ± 9.8%; 39 of 51 patients (76%) eventually underwent revascularization (38 by percutaneous coronary intervention and 1 by coronary artery bypass graft). By univariate analysis, minimum luminal diameter, MLA, lumen visibility by MSCT, and minimum luminal diameter by QCA were significant predictors of MLA by IVUS ≤4.0 mm². In mildly calcified lesions (calcium burden by MSCT ≤1), MLA by MSCT was a much better predictor than in more calcified lesions. By multivariate logistic regression analysis, only MLA by MSCT (odds ratio 0.754, 95% confidence interval 0.571 to 0.995, p = 0.0458) was predictive of MLA by IVUS ≤4.0 mm². In conclusion, in angiographically ambiguous lesions in which QCA does not distinguish significantly from nonsignificant stenosis, MSCT-measured MLA can predict significant stenosis with MLA ≤4.0 mm² measured by IVUS.