IVUS guided management of angiographic intermediate coronary lesions: Long-term outcome after stratification to PCI, CABG or medical therapy.

Abstract

Background: Intravascular ultrasound (IVUS), unlike coronary angiography, is useful in determining true morphologic severity of intermediate coronary lesions (ICL) and may be utilised to guide management strategies for these patients. There is limited Australian data on the clinical outcome of patients with ICL who undergo different management strategies based on IVUS. Aim(s): To determine the long-term clinical outcome of patients with ICL referred for IVUS who are stratified to PCI, CABG or medical therapy (MT). Method(s): Between January 2006 to June 2009, 184 patients with angiographic ICL underwent IVUS and were then stratified to PCI (n= 43), CABG (n= 73) or MT (n= 85) based on the operator's decision. Combined endpoints (CEP) of cardiac death, need for subsequent revascularization (TVR and CABG), congestive heart failure (CHF) or recurrent angina requiring admission were assessed by review of institutional database and phone follow up. Result(s): In the PCI, CABG and MT groups (95% follow up; male; 55%, 61+/- 12 years, 69%, 65 +/-12 years and 61%, 61 +/-10 years, risk factor profiles and follow-up duration; mean+/-SD: 632+/-310, 659+/-399 and 748+/-378 days were similar (all P= NS). Five MT patients required subsequent revascularisation (one T VR and 4 CABG) and one PCI patient required subsequent CABG. There was no difference in CEP (16%, 8%, 17%), mortality (5.4%, 7.4%, 1.2%), freedom from angina(93%,96%,92%) and CHF (95%,98%, 96%) in the PCI, CABG and MT groups respectively (all P=NS). Conclusion(s): IVUS guided stratification of angiographic intermediate coronary lesions to PCI, CABG or MT results in comparable and good long-term outcome.