Τίτλος:
Ruptured versus stable plaques in human coronary arteries
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Katritsis, D.G.
Efstathopoulos, E.P.
Pantos, I.
Tzanalaridou, E.
De Waha, A.
Siontis, G.C.M.
Toutouzas, K.
Redwood, S.
Kastrati, A.
Stefanadis, C.
Περιοδικό:
Coronary Artery Disease
Λέξεις-κλειδιά:
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
DOI:
10.1097/MCA.0b013e3283471f95
