Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Twenty eight patients with the diagnosis of Non ST Elevation Acute Coronary Syndromes. Coronary Angiography showed intermediate lesions assessed by QCA and IVUS. Percent area stenosis {u2265} 70%, MLA adjusted to the reference vessel diameter & MLA {u2264} 6mm2 for left main artery were the criteria for intervention. Three to six months clinical follow up regarding MACE and six months mortality.Results : Mean age was 53.2 ± 9.1 years. Males=20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) & DM in 8 (28.6%). Mean BMI=23.4 ± 2.9. Twenty three patients diagnosed as UA and five patients diagnosed as NSTEMI. Mean TIMI risk score 3.1±1.4. A statistically significant higher TIMI risk score in NSTEMI group (P=0.02). Multi-vessel disease in 17 patients (60.8%). Seventy six vessels were affected with 23 Culprit vessels, 44 non-culprit vessels & 9 left main vessels. Mean syntax score 17.5 ± 8.0. sixty one intermediate lesions were detected with higher fibrofatty structure. Negative remodeling in 51% of lesions. 29 lesions in culprit vessels & 32 lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P<0.001) while there was a higher calcific content in lesions of non-culprit vessels (P<0.001). 27 lesions were subjected to revascularization based on IVUS measures. QCA Minimum lumen diameter was significantly lower (P=0.002) and percent diameter stenosis was significantly higher in revascularization group (P=0.02). MLA was significantly lower (P<0.001) and Percent area stenosis was significantly higher in revascularization group (P<0.001). MLA & plaque burden are the main predictors for lesion anatomical significance with (P <0.001, OR=0.25, 95% CI = 0.12-0.55) and (P=0.011 , OR=2.0 , 95% CI = 1.2-3.3) respectively related to the use of IVUS

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