Avaliação ultrassonográfica intracoronária da carga aterosclerótica no tronco da artéria coronária esquerda prediz a extensão da doença no restante da árvore coronária: análise piloto

BACKGROUND: Non-cardiac atherosclerotic imaging, including carotid ultrasound, has been proposed as an indirect way to estimate coronary risk. The authors hypothesize that the isolated assessment of the left main coronary artery (LMCA) could predict the atherosclerotic burden in the remainder of the coronary tree. METHODS: The study included patients with a diagnosis of coronary artery disease with an indication for percutaneous coronary intervention (PCI), without significant LMCA stenosis. During PCI, LMCA and three-vessel intravascular ultrasound (IVUS) examination was performed and the lumen area, external elastic membrane area, plaque area, and plaque burden were measured. RESULTS: A total of 17 patients were included with mean age of 56 ± 8.9 years, 71% male, and 41% diabetics. Although none of the patients had LMCA stenosis by angiography or IVUS, evidence of atherosclerosis was observed with a plaque area of 8.4 ± 2.7 mm2 and plaque burden of 33.5 ± 8.9%. A significant correlation between the LMCA and the rest of the coronary arteries was observed for all IVUS parameters: lumen area (r = 0.5), external elastic membrane area (r = 0.7); plaque area (r = 0.6), and plaque burden (r = 0.4). CONCLUSIONS: In this pilot study, the coronary atherosclerotic burden could be estimated from the isolated assessment of the LMCA by IVUS. Such an association is relevant for the development of future coronary risk scores, as a surrogate marker of the global coronary tree atherosclerotic burden.