Optimal intravascular ultrasound criteria and their accuracy for defining the functional significance of intermediate coronary stenoses of different locations

Bon Kwon Koo, Hyoung Mo Yang, Jun Hyung Doh, Hyunmin Choe, Sung Yun Lee, Chang Hwan Yoon, Yun Kyeong Cho, Chang Wook Nam, Seung Ho Hur, Hong Seok Lim, Myeong Ho Yoon, Kyung Woo Park, Sang Hoon Na, Tae Jin Youn, Woo Young Chung, Seunghyun Ma, Sue Kyung Park, Hyo Soo Kim, Seung Jea Tahk

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Objectives: We performed this study to determine the optimal intravascular ultrasound (IVUS) criteria and to evaluate their accuracy for defining the functional significance of intermediate coronary stenoses in different locations of the coronary tree. Background: Presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease and is determined by both the lesion severity and the amount of myocardium supplied. Methods: IVUS and fractional flow reserve (FFR) measurements were performed in 267 intermediate lesions located at the proximal or mid part of major epicardial coronary arteries. Optimal IVUS criteria and their diagnostic accuracy for functionally significant stenoses (FFR <0.8) were assessed. Results: FFR was <0.8 in 88 lesions (33%). The determinants of FFR were minimum lumen area (MLA) and lesion location. The diagnostic accuracy of MLA was highly variable according to the location of lesions. The best cutoff value of MLA to define the functional significance was 3.0 mm 2 (area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.91) for proximal left anterior descending artery (LAD) lesions and 2.75 mm 2 for mid-LAD lesions located before the second diagonal branch (AUC: 0.76, 95% CI: 0.66 to 0.84). However, the appropriate MLA to predict the functional significance of lesions could not be found in other segments. Conclusions: When IVUS parameters are used to determine the functional significance of lesions in patients with intermediate coronary artery stenoses, different criteria should be used according to lesion location. In segments or vessels with anatomic variations, IVUS cannot be used for functional assessment of a stenosis. (Comparison of Fractional Flow Reserve and Intravascular Ultrasound; NCT01133015)

Original languageEnglish
Pages (from-to)803-811
Number of pages9
JournalJACC: Cardiovascular Interventions
Issue number7
StatePublished - 1 Jul 2011


  • coronary disease
  • fractional flow reserve
  • intravascular ultrasound
  • physiology
  • stenosis

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