TY - JOUR
TI - Three-dimensional analysis of vulnerable segments in the left anterior descending artery
AU - Katritsis, D.G.
AU - Pantos, I.
AU - Korovesis, S.
AU - Hadjipavlou, M.
AU - Tzanalaridou, E.
AU - Lockie, T.
AU - Redwood, S.
AU - Voridis, E.
AU - Efstathopoulos, E.P.
JO - Coronary Artery Disease
PY - 2009
VL - 20
TODO - 3
SP - 199-206
PB - 
SN - 0954-6928, 1473-5830
TODO - 10.1097/MCA.0b013e32832397fe
TODO - adult;  aged;  angiocardiography;  comparative study;  controlled study;  coronary artery atherosclerosis;  coronary artery disease;  disease predisposition;  female;  heart infarction;  human;  left anterior descending coronary artery;  major clinical study;  male;  multivariate logistic regression analysis;  priority journal;  review;  ST segment elevation;  three dimensional imaging;  thrombosis;  angiocardiography;  article;  biological model;  computer assisted diagnosis;  coronary artery obstruction;  coronary artery thrombosis;  heart infarction;  hospitalization;  middle aged;  prediction and forecasting;  radiography;  risk assessment;  sensitivity and specificity;  statistical model, Aged;  Coronary Angiography;  Coronary Stenosis;  Coronary Thrombosis;  Female;  Humans;  Imaging, Three-Dimensional;  Logistic Models;  Male;  Middle Aged;  Models, Cardiovascular;  Myocardial Infarction;  Predictive Value of Tests;  Radiographic Image Interpretation, Computer-Assisted;  Risk Assessment;  Sensitivity and Specificity;  Severity of Illness Index
TODO - OBJECTIVES: Analysis of conventional angiograms has suggested that specific anatomic parameters of particular segments of a coronary artery render them prone to vulnerable plaque development, plaque rupture, and consequent thrombosis. This study aimed at performing a three-dimensional analysis of recanalized left anterior descending (LAD) coronary arteries in patients who had suffered an anterior ST-elevation myocardial infarction (STEMI). METHODS: Coronary angiograms of 76 consecutive patients with an anterior STEMI and a recanalized LAD were reconstructed in the three-dimensional space, and compared with angiograms of 76 patients with stable coronary artery disease (SCAD) and significant LAD stenosis. RESULTS: In both groups the majority of lesions occurred between 20 and 40 mm (P=0.745), but the number of lesions beyond 60 mm from the ostium was significantly higher in SCAD compared with STEMI (P=0.045). Culprit lesions were statistically significantly longer in patients with STEMI compared with SCAD (18.3±7.5 vs. 12.7±6.2 mm, P<0.001). Cut-off point analysis indicated a lesion length of ≥ 12.5 mm as discriminating threshold between SCAD and STEMI (sensitivity 79% and specificity 63%). Bifurcation branches on the culprit lesion were seen in 79% of the patients with STEMI and 58% of those with SCAD (P=0.026). Lesion angulation was significantly sharper in STEMI compared with SCAD patients in diastole (155±15 vs. 160±14 degrees, P=0.037). Multiple logistic regression model including these parameters had a high discriminating ability with c-statistic 0.78 (95% confidence intervals: 0.71-0.86), sensitivity 72.4%, and specificity 75%. CONCLUSION: Specific anatomic characteristics of LAD segments predispose to development of plaque rupture and thrombosis. © 2009 Lippincott Williams & Wilkins, Inc.
ER -