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European Heart Journal 2002 23(3):247-254; doi:10.1053/euhj.2001.2730
Copyright © 2002 by the European Society of Cardiology.
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Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries

C. Briguoria, J. Tobisb, T. Nishidac, M. Vaghettic, R. Albieroc, C. Di Marioa and A. Colomboa,c,f1

a San Raffaele Hospital, Milan, Italy
b Division of Cardiology, Department of Medicine, University of California, Los Angeles Medical Center, California, U.S.A.
c Centro Cuore Columbus, Milan, Italy

revised April 3, 2001; accepted April 4, 2001

Abstract

Aims A small reference diameter may be the consequence of high plaque burden and diffuse disease. The reference vessel diameter in small coronary arteries may vary according to the method of measurement used. We endeavoured to confirm the difference between data from examinations conducted using angiography with that revealed by intravascular ultrasound.

Methods and Results Between March 1993 and October 1999, 344 consecutive patients with 419 lesions in small vessels (≤2·75mm, Small group) and 953 patients with 1161 lesions in large vessels (Large group) underwent intravascular ultrasound-guided percutaneous transluminal angioplasty in our Institution. The mean difference between the intravascular ultrasound and the angiographic reference diameter ({Delta}IVUS-Angio) was 1·3±0·5mm in the Small group and 1·0±0·6mm in the Large group (P<0·001). There was a stronger correlation between plaque burden and {Delta}IVUS-Angioin the Small group (r=0·80, P<0·001) than in the Large group (r=0·59,P <0·001). An {Delta}IVUS-Angio≥0·30mm occurred in 99·5% of cases in the Small group and in 90% in the Large group (P<0·001). An {Delta}IVUS-Angio≥0·50mm occurred in 96% of case in the Small group and 80% in the Large group (P<0·001). Predictors of {Delta}IVUS-Angio≥0·50 in the Small group were: proximal or middle lesion site, vessel type (left anterior descending artery, diagonal and obtuse marginal branches) and female sex. An {Delta}IVUS-Angio≥1·0mm occurred in 71% of cases in the Small group and in 49% in the Large group (P<0·001). Predictors of {Delta}IVUS-Angio≥1·0mm in the Small group were: proximal or middle lesion site, female sex, and lesion length.

Conclusions A high percentage of vessels measuring ≤2·75mm are large vessels with a high plaque burden. This condition is particularly prevalent in females, with lesions in the proximal or middle left anterior descending artery, and in obtuse marginal and diagonal branches.

Key Words: Small vessels, quantitative coronary angiography, intravascular ultrasound

f1 Correspondence: Antonio Colombo, MD, FESC, Centro Cuore Columbus, Via M. Buonarroti, 48, I-20145, Milan, Italy.

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