Cardiologie [Cardiology]

This article reviews: 1) some of the results of drug eluting stents (SYNTAX and FAME); 2) the questionnable benefit of physical training in heart failure patients (HF-ACTION); 3) the benefit on cardiac remodelling of cardiac resynchronisation in heart failure patients (REVERSE study) and 4) the role of rate over rhythm control in patients with atrial fibrillation and heart failure (AF-CHF study); this article also reports the encouraging evolution of new technology allowing percutaneous implantation of stents-valves. Finally, this article address the screening of athletes for cardiac diseases.

Cardiologie [Cardiology]

Heart failure and atrial fibrillation are the main problems in general cardiology. Our therapeutic reflections summarize new ideas in the treatment of theses pathologies but we will not forget importance of PCI. All these therapies have proven now the clinical benefit but also reduction in more morbidity and mortality. Cardiac resynchronisation therapy has shown promising results. The art of medicine to develop will be to better identify the patients benefiting from this therapy. Interventional cardiology is focusing on the acute coronary syndrome. Not only rapid intervention but also the stent technology allow significant modification of endothelial tissue reaction and therefore improve the general benefit for the patient.

Brugada syndrome unmasked by accidental inhalation of gasoline vapors.

Loss-of-function mutations in the gene SCN5A can cause Brugada syndrome (BrS), which is an inherited form of idiopathic ventricular fibrillation. We report the case of a 46-year-old patient, with no previous medical history, who had ventricular fibrillation after accidental inhalation of gasoline vapors. His electrocardiogram (ECG) showed a typical type-1 BrS pattern that persisted after the acute event. Genetic investigations allowed the identification of a novel SCN5A mutation leading to a frame-shift and early termination of the channel protein. Biochemical and cellular electrophysiology experiments confirmed the loss-of-function of the mutant allele. The patient was implanted with a cardioverter/defibrillator.

Manifestations électrocardiographiques de l'hyperkaliémie modérée à sévère

L'hyperpotassémie est un désordre électrolytique, qui dans des situations extrêmes, peut conduire au décès. Les premières études effectuées montraient un lien entre la progression du taux de potassium et l'apparition de modifications électrocardiographiques. Certaines études, plus récentes, ont mis en doute cette hypothèse. Notre étude a pour but de chercher quels sont les facteurs associés à l'apparition d'un pattern électrocardiographique typique, en cas d'hyperpotassémie modérée à sévère (≥7mmol/l), dans une population adulte hospitalière, non sélectionnée. Le 2ème objectif est d'estimer la mortalité liée à ce degré d'hyperkaliémie. Etude au design rétrospectif, sélectionnant les patients adultes avec K : ≥ 7mmol/L, entre 2009 et 2010 au CHUV, ayant un électrocardiogramme à disposition entre -1h et +2h de la prise de sang. Recueil des valeurs de laboratoires et des comorbidités de ces patients et analyse des électrocardiogrammes : fréquence cardiaque, durée QRS, durée QTc, amplitudes ondes T et RS, présence d'un trouble de la conduction, d'une fibrillation ou d'un flutter, d'un rythme jonctionnel. Résultats : Sur les 82 patients sélectionnés, l'analyse statistique a mis en évidence que le taux de potassium n'est corrélé ni à l'apparition de modifications électrocardiographiques typiques, ni à la mortalité. Le seul élément pouvant prédire, sur l'électrocardiogramme, l'apparition d'un pattern typique est le degré d'acidémie. Le risque de décès ou de présenter un arrêt cardiorespiratoire en cas d'hyperkaliémie modérée à sévère est principalement déterminé par la présence d'une acidose métabolique.

L'arrêt cardiaque: quelle réalité et quelle formation pour le praticien [Heart arrest: which reality and which training for the practitioner?]

Sudden death related to out-of hospital cardiac arrest is an important cause of mortality, which is mainly caused by ventricular fibrillation, a potentially reversible condition. The prognosis of out-of-hospital cardiac arrest remains dismal despite well developed emergency medical services. Witnessed arrest, ventricular fibrillation as the initial arrhythmia, cardiopulmonary resuscitation and early defibrillation are systematically associated with better survival. Key interventions must therefore be enforced to improve survival from out-of-hospital cardiac, introducing the concept of a "chain of survivals". The aim of the present article, which is illustrated by local results, is to review this important public health issue, to emphasize the role of the general practitioner in the chain of survival, and to promote education and training of basic and advanced life support.

Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction.

OBJECTIVES: We assessed the clinical characteristics of patients with acute ischemic stroke (AIS) with left ventricular ejection fraction (EF) ≤ 35% and investigated the association of low EF with early and long-term outcome. METHODS: A total of 2439 patients of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) were selected. Demographics, risk factors, pre-stroke treatment, and clinical, radiological and metabolic variables in patients with and without low EF were compared. Functional independence (modified Rankin Score ≤ 2) and mortality were recorded 1 week up to 12 months from admission. RESULTS: Low EF patients (n=119) were more commonly men, older, had higher rates of coronary artery disease and atrial fibrillation (AF), and more frequent pretreatment with anticoagulants, antiplatelets and antihypertensive agents. On admission, they presented with higher stroke severity and had lower values of systolic blood pressure, higher heart rate, and worse estimated glomerular filtration rate. Stroke-related disability and death rates were higher in low EF patients during follow-up (19.5% vs. 7.8% at 1 week, and 36.1% vs. 16.5% at 12 months). Increasing age, stroke severity, and AF were independent predictors of one-year mortality in these patients while prior use of statins had a favorable effect on early mortality. CONCLUSIONS: AIS in patients with low EF is associated with older age, cardiac comorbidities, and more severe clinical presentation. Low EF can identify a subset of AIS patients at high risk of early and long-term functional disability and mortality.

Kinetics of atrial repolarization alternans in a free-behaving ovine model.

Kinetics of Atrial Repolarization Alternans. INTRODUCTION: Repolarization alternans (Re-ALT), a beat-to-beat alternation in action potential repolarization, promotes dispersion of repolarization, wavebreaks, and reentry. Recently, Re-ALT has been shown to play an important role in the transition from rapid pacing to atrial fibrillation (AF) in humans. The detailed kinetics of atrial Re-ALT, however, has not been reported so far. We developed a chronic free-behaving ovine pacing model to study the kinetics of atrial Re-ALT as a function of pacing rate. METHODS: Thirteen sheep were chronically implanted with 2 pacemakers for the recording of broadband right atrial unipolar electrograms and delivery of rapid pacing protocols. Beat-to-beat differences in the atrial T-wave apex amplitude as a measure of Re-ALT and activation time were analyzed at incremental pacing rates until the effective refractory period (ERP) defined as stable 2:1 capture. RESULTS: Atrial Re-ALT appeared intermittently but without periodicity, and increased in amplitude as a function of pacing rate until ERP. Intermittent 2:1 atrial capture was observed at pacing cycle lengths 40 ms above ERP, and increased in duration as a function of pacing rate. Episodes of rapid pacing-induced AF were rare, and were preceded by Re-ALT or complex oscillations of atrial repolarization, but without intermittent capture. CONCLUSION: We show in vivo that atrial Re-ALT developed and increased in magnitude with rate until stable 2:1 capture. In rare instances where capture failure did not occur, Re-ALT and complex oscillations of repolarization surged and preceded AF initiation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1003-1012, September 2012).

What influence do anticoagulants have on oral implant therapy? A systematic review.

OBJECTIVES: This systematic review aims to assess the risks (both thromboembolic and bleeding) of an oral anticoagulation therapy (OAT) patient undergoing implant therapy and to provide a management protocol to patients under OAT undergoing implant therapy. MATERIAL AND METHODS: Medline, Cochrane Data Base of Systematic Reviews, the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. This search was completed by a hand research accessing the references cited in all identified publications. RESULTS: Nineteen studies were identified reporting outcomes after oral surgery procedures (mostly dental extractions in patients on OAT following different management protocols and haemostatic therapies). Five studies were randomized-controlled trials (RCTs), 11 were controlled clinical trials (CCTs) and three were prospective case series. The OAT management strategies as well as the protocols during and after surgery were different. This heterogeneity prevented any possible data aggregation and synthesis. The results from these studies are very homogeneous, reporting minor bleeding in very few patients, without a significant difference between the OAT patients who continue with the vitamin K antagonists vs. the patients who stopped this medication before surgery. These post-operative bleeding events were controlled only with local haemostatic measures: tranexamic acid mouthwashes, gelatine sponges and cellulose gauzes's application were effective. Post-operative bleeding did not correlate with the international normalised ratio (INR) status. In none of the studies was a thromboembolic event reported. CONCLUSIONS: OAT patients (INR 2-4) who do not discontinue the AC medication do not have a significantly higher risk of post-operative bleeding than non-OAT patients and they also do not have a higher risk of post-operative bleeding than OAT patients who discontinue the medication. In patients with OAT (INR 2-4) without discontinuation, topical haemostatic agents were effective in preventing post-operative bleeding. OAT discontinuation is not recommended for minor oral surgery, such as single tooth extraction or implant placement, provided that this does not involve autogenous bone grafts, extensive flaps or osteotomy preparations extending outside the bony envelope. Evidence does not support that dental implant placement in patients on OAT is contraindicated.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Uso de la hipotermia en el síndrome posparada cardíaca

Antecedentes: La parada cardiorrespiratoria es uno de los principalesproblemas sanitarios en los países desarrollados, además de por la mortalidadproducida, por las importantes repercusiones neurológicas posteriores quepresentan las personas que sobreviven. Hasta un 64% de los supervivientespuede presentar secuelas de gravedad, y tan solo un 1,4% queda exento dealgún tipo de alteración neurológica. Distintos ensayos clínicos, muestran quela hipotermia inducida ligera, es decir, el descenso controlado de latemperatura corporal mejora la supervivencia y los daños neurológicos en lospacientes adultos inconscientes tras una resucitación cardiopulmonar. Sinembargo, no está del todo claro cuáles son los pacientes más indicados pararecibir la terapia, la técnica de inducción ideal, la temperatura objetivo, suduración y la tasa idónea de recalentamiento.Objetivos: El objetivo del estudio es conocer la técnica de hipotermiaterapéutica como cuidado posresucitación tras sufrir una parada cardíaca.Metodología: Para ello, se realizó una búsqueda bibliográfica a través de lassiguientes bases de datos: CSIC, Medline PubMed, CINAHL, BibliotecaCochrane, Cuiden Plus, Dialnet, Scopus y ScienceDirect. Finalmente, seaceptaron 8 artículos que pertenecían a los criterios de inclusión: revisionessistemáticas, ensayos clínicos, revisiones bibliográficas y documentos deconsenso tras consejo de expertos, en español o inglés, publicados desde elaño 2005 hasta el año 2013 cuyos sujetos de estudio son adultos.Resultados: en la actualidad, se recomienda que los pacientes adultosinconscientes, con recuperación de la circulación espontánea tras una paradacardíaca extrahospitalaria, deben ser enfriados a 32-34ºC durante un periodode 12-24 horas cuando el ritmo inicial sea fibrilación ventricular. Se establecen4 periodos de tratamiento: inducción (desde el ingreso en la unidad hasta quese alcanzan los 33ºC), mantenimiento (desde el logro de los 33ºC hasta 24horas después), recalentamiento (12 horas de incremento de la temperatura,hasta alcanzar los 37ºC) y estabilización térmica (12 horas posteriores aalcanzar los 37ºC). Los métodos de inducción y mantenimiento de la hipotermiason diversos y se establecen dos grupos: técnicas invasivas y no invasivas.Palabras clave: hipotermia inducida, parada cardíaca, técnicas enfriamiento

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Ischaemic heart disease as the result of impaired blood supply is currently the leading cause of failure and death. Ischaemic heart disease refers to a group of clinicopathological symptoms including angina pectoris, acute myocardial infection, chronic ischemic heart disease, as well as heart failure and sudden cardiac death. Coronary artery ischemic heart disease, as well as heart failure and sudden cardiac death. Coronary artery thrombosis is the most common cause of acute myocardial infarction and sudden cardiac death. A thrombotic event is the result of two different processes: plaque disruption and endothelial erosion. The morphology of a "vulnerable plaque" is more clinically indicative than the plaque volume and the degree of luminal stenosis. However, identification of patients with vulnerable plaques remains very challenging and demands the development of new methods of coronary plaque imaging. Sudden death resulting from ventricular fibrillation or AV block frequently complicates coronary thrombosis, accounting for up to 50% of mortality.If a coronary artery is occluded for more than 20 min, irreversible damage to the pericardium occurs. Timely coronary recanalization and myocardial reperfusion limit the extent of myocardial necrosis, but may induce "reperfusion injuries", stunned myocardium, or reperfused myocardial hemorrhagic infarcts, all of which are related to infarct siz and coronary occlusion time. Reperfusion injuries have been described after cardiac surgery, percutaneous transluminal coronary angioplasty, and fibrinolysis. A prolonged imbalance between the supply of and demand for myocardial oxygen and nutrition leads to a subacute, acute, or chronic state (aka hibernating myocardium) of myocardial ischemia. Ischemic heart disease is bwelieved to be the underlying cause of heart failure in approximately two-thirds of patients, resulting from acute and/or chronic injury to the heart.

Risk factor profile and management of cerebrovascular patients in the REACH Registry.

BACKGROUND: Cerebrovascular disease (CVD) is a global public health problem. CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Prevalence of risk factors, comorbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. We assessed these factors in 18,992 CVD patients within a worldwide registry of stable outpatients. METHODS: The Reduction of Atherothrombosis for Continued Health Registry recruited >68,000 outpatients (44 countries). The subjects were mainly recruited by general practitioners (44%) and internists (29%) if they had symptomatic CVD, coronary artery disease, peripheral arterial disease (PAD) and/or >or=3 atherothrombotic risk factors. RESULTS: The 18,992 CVD patients suffered a stroke (53.7%), transient ischemic attack (TIA) (27.7%) or both (18.5%); 40% had symptomatic atherothrombotic disease in >or=1 additional vascular beds: 36% coronary artery disease; 10% PAD and 6% both. The prevalence of risk factors at baseline was higher in the TIA subgroup than in the stroke group: treated hypertension (83.5/82.0%; p = 0.02), body mass index >or=30 (26.7/20.8%; p < 0.0001), hypercholesterolemia (65.1/52.1%; p < 0.0001), atrial fibrillation (14.7/11.9%; p < 0.0001) and carotid artery disease (42.3/29.7%; p < 0.0001). CVD patients received antiplatelet agents (81.7%), oral anticoagulants (17.3%), lipid-lowering agents (61.2%) and antihypertensives (87.9%), but guideline treatment targets were frequently not achieved (54.5% had elevated blood pressure at baseline, while 4.5% had untreated diabetes). CONCLUSIONS: A high percentage of CVD patients have additional atherothrombotic disease manifestations. The risk profile puts CVD patients, especially the TIA subgroup, at high risk for future atherothrombotic events. Undertreatment is common worldwide and adherence to guidelines needs to be enforced.

The role of neutrophils upon leishmania major infection

Les neutrophiles constituent la première ligne de défense contre un grand nombre de pathogènes. Après infection avec Leishmania major, les neutrophiles migrent rapidement et massivement au site d'infection par le parasite. Les neutrophiles sont d'importants acteurs dans l'orchestration de la réponse anti-Leishmania, via la sécrétion de nombreuses cytokines, chimiokines et composés stockés dans leurs granules. De plus, les neutrophiles interagissent avec les cellules présentatrices d'antigènes, telles que les cellules dendritiques et en conséquences contribuent au développement de la réponse adaptative. A ce jour, l'impact des neutrophiles sur 1'activation des cellules dendritiques et les possibles conséquences de l'interaction neutrophiles avec ces dernières sur l'évolution de la maladie suite à l'infection avec L. major reste peu connu. Ainsi, nous avons dans un premier temps investigué l'influence des neutrophiles sur 1'activation des cellules dendritiques in vitro. Suite à cela, nous avons analysé le rôle des neutrophiles sur 1'activation des cellules dendritiques présentes au site d'infection et dans les ganglions drainants in vivo, après inoculation intra-dermale de L. major dans le pavillon auriculaire de souris de souche C57BL/6 et BALB/c, ainsi que les conséquences de la déplétion des neutrophiles sur l'évolution de la maladie. Nous avons pu démontrer que les neutrophiles ont un impact négatif sur l'activation des cellules dendritiques exposées à L. major in vitro, via des mécanismes impliquant la sécrétion de Prostaglandines par les neutrophiles et la séquestration des parasites. La déplétion des neutrophiles dans les souris BALB/c durant les premiers jours après infection avec L. major dans le derme de l'oreille résulte en une augmentation de l'expression de marqueurs d'activation des cellules dendritiques présentes dans les ganglions drainants, mais pas au site d'infection. De plus, les souris BALB/c transitoirement déplétées en neutrophiles développent des lésions significativement plus petites, une réponse de type Th2 diminuée et une charge parasitaire plus faible au site d'infection que les souris non déplétées. La déplétion des neutrophiles dans les souris C57BL/6 n'a pas d'influence détectable sur l'activation des cellules dendritiques que ce soit au niveau des ganglions drainants ou au site d'infection. La progression de la lésion et la charge parasitaire ne sont pas affectées par la déplétion des neutrophiles, malgré le développement d'une réponse Th2 diminuée par rapport aux souris non déplétées. En résumé, dans les premières heures après infection, les neutrophiles ont un effet négatif sur l'activation des cellules dendritiques et sur la réponse anti-Leishmania dans les souris BALB/c tandis que leur rôle paraît moins important dans les souris C57BL/6. Ces résultats peuvent avoir d'importantes implications en terme de développement de nouveaux vaccins contre Leishmania. - Neutrophils constitute the first line of defense against a variety of pathogens. Following Leihmania major infection neutrophils migrate rapidly and massively to the site of parasite inoculation. They are important players in the orchestration of the anti-leishmania response through the release of a plethora of cytokines, chemokines and granular components. In addition, neutrophils interact with antigen-presenting cells such as dendritic cells (DCs) and thereby contribute to the development of the adaptive immune response. However, the impact of neutrophils on the activation of DCs and possible consequences on disease progression following L. major infection are poorly understood. Therefore, we first investigated the influence of neutrophils on DC activation in vitro. Next we analyzed the role of neutrophils on the activation of DCs present at the site of infection and in the draining lymph node (dLN) following inoculation of L. major in the ear pinna of C57BL/6 and BALB/c mice and analyzed the consequences of early neutrophil depletion on disease progression. We could demonstrate that neutrophils had a negative impact on the activation of DCs exposed to L. major in vitro through mechanisms involving neutrophil-derived prostaglandins and sequestration of parasites. In BALB/c mice, depletion of neutrophils during the first days of infection with L. major in the ear dermis increased the expression of activation markers on dLN DCs but not on DCs present at the site of infection. In addition, BALB/c mice transiently depleted of neutrophils developed significantly smaller lesions, a decreased Th2 immune response and harbored fewer parasites at the site of infection compared to non-depleted littermates. In C57BL/6, mice early depletion of neutrophils had no detectable impact on the activation of DCs both at the site of infection and in the dLN following L. major inoculation. Furthermore, depletion of neutrophils had no major effect on lesion evolution and parasite loads despite the development of a decreased Th2 immune response compared to non- depleted littermates. In summary, at the onset of infection, neutrophils are detrimental for DC activation and the anti-leishmania response in BALB/c mice while their role appears to be less important in C57BL/6 mice. These findings could have important implications for the design of new vaccination strategies.

Subclinical Thyroid Dysfunction and the Risk of Heart Failure in Older Persons at High Cardiovascular Risk.

Context: Subclinical thyroid dysfunction is common in older people. However, its clinical importance is uncertain. Objective: Our objective was to determine the extent to which subclinical hyperthyroidism and hypothyroidism influence the risk of heart failure and cardiovascular diseases in older people. Setting and Design: The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) is an prospective cohort study. Patients: Patients included men and women aged 70-82 yr (n = 5316) with known cardiovascular risk factors or previous cardiovascular disease. Main Outcome Measures: Incidence rate of heart failure hospitalization, atrial fibrillation, and cardiovascular events and mortality according to baseline thyroid status were evaluated. Euthyroid participants (TSH =0.45-4.5 mIU/liter) were compared with those with subclinical hyperthyroidism (TSH <0.45 mIU/liter) and those with subclinical hypothyroidism (TSH ≥4.5 mIU/liter, both with normal free T(4)). Results: Subclinical hyperthyroidism was present in 71 participants and subclinical hypothyroidism in 199 participants. Over 3.2 yr follow-up, the rate of heart failure was higher for subclinical hyperthyroidism compared with euthyroidism [age- and sex-adjusted hazard ratio (HR) = 2.93, 95% confidence interval (CI) = 1.37-6.24, P = 0.005; multivariate-adjusted HR = 3.27, 95% CI = 1.52-7.02, P = 0.002). Subclinical hypothyroidism (only at threshold >10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR = 3.01, 95% CI = 1.12-8.11, P = 0.029; multivariate HR = 2.28, 95% CI = 0.84-6.23). There were no strong evidence of an association between subclinical thyroid dysfunction and cardiovascular events or mortality, except in those with TSH below 0.1 or over 10 mIU/liter and not taking pravastatin. Conclusion: Older people at high cardiovascular risk with low or very high TSH along with normal free T(4) appear at increased risk of incident heart failure.

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective: To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents. Design: Prospective, observational single centre study. Setting: A single tertiary referral centre. Patients: Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure. Interventions: MSCT and IVUS imaging at 912 months follow-up were performed for all patients. Main outcome measures: Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS. Results: 52 patients were analysed. PassingBablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT. Conclusions: Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis