TY - JOUR
TI - Ruptured versus stable plaques in human coronary arteries
AU - Katritsis, D.G.
AU - Efstathopoulos, E.P.
AU - Pantos, I.
AU - Tzanalaridou, E.
AU - De Waha, A.
AU - Siontis, G.C.M.
AU - Toutouzas, K.
AU - Redwood, S.
AU - Kastrati, A.
AU - Stefanadis, C.
JO - Coronary Artery Disease
PY - 2011
VL - 22
TODO - 5
SP - 345-351
PB - 
SN - 0954-6928, 1473-5830
TODO - 10.1097/MCA.0b013e3283471f95
TODO - adult;  angiocardiography;  artery diameter;  artery rupture;  artery thrombosis;  artery wall;  article;  atherosclerotic plaque;  cardiac patient;  cardiovascular risk;  controlled study;  coronary artery;  coronary artery atherosclerosis;  coronary artery bifurcation;  coronary artery obstruction;  female;  human;  left anterior descending coronary artery;  major clinical study;  male;  priority journal;  ST segment elevation myocardial infarction;  three dimensional imaging, Aged;  Coronary Angiography;  Coronary Stenosis;  Coronary Thrombosis;  Coronary Vessels;  Female;  Humans;  Logistic Models;  Male;  Middle Aged;  Myocardial Infarction;  Plaque, Atherosclerotic;  Rupture, Spontaneous
TODO - Objective: To derive a model for the identification of left anterior descending (LAD) coronary artery stenoses predisposed to plaque rupture and thrombosis. Methods: Coronary angiograms of 186 consecutive patients (original sample) with an anterior ST elevation myocardial infarction (STEMI) and a recanalized LAD were reconstructed in the three-dimensional space. Culprit lesions were compared with 293 stable LAD coronary stenoses on the same patients. A model for predicting stenoses with a high probability of thrombosis was derived and validated in 50 subsequent patients with STEMI, and 50 patients with stable lesions (validation sample). Results: The majority of culprit lesions occurred between 20 and 40 mm from the LAD ostium, whereas the majority of stable lesions were found in a distance of more than 60 mm (P<0.001). Culprit lesions were statistically significantly longer than stable ones (23.2±10.4 mm vs. 14.7±7.2 mm; P<0.001). Bifurcations on culprit lesions were significantly more frequent (86.6%) compared with stable lesions (41.3%, P<0.001). Lesion angulation was significantly sharper in culprit lesions, which were symmetrical whereas stable lesions resided in the inner vessel wall in respect to the local vessel curvature. A simple additive tool was developed by using these parameters in a multiple regression model. The discriminating ability of the proposed index was high in both the original [area under the receiver operating characteristic curve: 0.88 (95% confidence interval: 0.85-0.91)] and validation sample [area under the receiver operating characteristic curve: 0.69 (95% confidence interval: 0.59-0.78)]. Conclusion: Specific anatomic characteristics of LAD segments associated with STEMI can be identified on coronary angiograms and assist the risk stratification of coronary stenoses. © 2011 Wolters Kluwer Health. Lippincott Williams & Wilkins.
ER -