Atherosclerosis in angiographically “normal” coronary artery reference segments: An intravascular ultrasound study with clinical correlations
Key result
IVUS reveals only ~7% of angiographically normal coronary segments are truly disease-free.
- n=884
Why the study?
The extent of coronary atherosclerosis is underestimated by visual analysis of angiographically normal coronary artery segments, necessitating detailed in vivo imaging.
Population
884 patients evaluated for transcatheter therapy for symptomatic native coronary artery disease
Comparison
Angiographically normal coronary artery reference segments assessed by intravascular ultrasound
Design
Observational intravascular ultrasound study
Follow-up
12 months
Authors
Discussion
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Implication
Atherosclerosis is ubiquitous in angiographically normal coronary artery reference segments when assessed by intravascular ultrasound, highlighting the limitations of visual angiographic assessment.
Key Points
- To evaluate the magnitude, morphologic patterns, and clinical predictors of atherosclerotic plaque within angiographically normal coronary reference segments.
- Evaluated 884 patients undergoing diagnostic assessment or transcatheter therapy for symptomatic native coronary artery disease using intravascular ultrasound (IVUS).
- Defined reference segments as the most visually normal cross section by IVUS within 10 mm proximal to the target lesion and distal to major side branches, assessing outcomes through 12 months.
- Only 60 of 884 (6.8%) angiographically normal reference segments appeared normal on IVUS, demonstrating an average cross-sectional narrowing of 51 ± 13% that correlated weakly with target lesion narrowing (r = 0.166, p < 0.0001).
- Predictors of reference segment narrowing included male sex, age, diabetes, hypercholesterolemia, and multivessel disease, with treated patients exhibiting a greater arc of calcium than diagnostic patients (43 ± 81 vs. 25 ± 57, p = 0.015).
- Reference segment plaque severity did not independently predict subsequent angiographic restenosis or adverse clinical events within 12 months of follow-up.
Study Design
Type
Observational (n=884)
Structured PICO
P
Population
884 patients evaluated for transcatheter therapy for symptomatic native coronary artery disease who underwent intravascular ultrasound of angiographically normal reference segments.
E
Exposure
Intravascular ultrasound (IVUS) imaging of angiographically normal coronary artery reference segments
O
Outcome
Magnitude, patterns, and clinical correlates of atherosclerosis in angiographically normal reference segmentssurrogate
Atherosclerosis is ubiquitous in angiographically normal coronary artery reference segments when assessed by intravascular ultrasound, highlighting the limitations of visual angiographic assessment.
Cite This Study
Mintz et al. (1995) conducted an observational in Symptomatic native coronary artery disease (n=884). Angiographically normal coronary artery reference segments was evaluated on Normalcy by intravascular ultrasound. Intravascular ultrasound revealed that only 6.8% of angiographically normal coronary artery reference segments were truly normal, with a mean cross-sectional narrowing of 51%.