Evolving cutoff values for optimising left main stenting with intravascular imaging

The value of intravascular imaging (IVI) to improve clinical outcomes after left main (LM) revascularisation has been the subject of multiple studies, with some attempting to identify specific minimum stent area (MSA) targets123.

It is worth noting that it is not just a matter of using IVI but of using it in an actionable way and oriented towards achieving certain targets, since the observable long-term prognostic benefit will depend on this4.

The group of investigators behind the study discussed in this editorial pioneered in defining these optimisation criteria, identifying an easy numerical series 5-6-7-8 mm2 for the MSA cutoff values in the ostial left circumflex (LCx), ostial left anterior descending (LAD), LM polygon of confluence, and LM above the polygon of confluence, respectively1.

These threshold values for MSA, derived from an Asian population, were notably lower than those found in a trial conducted in a Western population: 6, 7, and 10 mm2 for the LCx, LAD, and LM, respectively2.

Recently, the same authors revised the previous MSA criteria based on the 5-year clinical outcomes in patients undergoing upfront...