Τίτλος:
Three-dimensional analysis of vulnerable segments in the left anterior descending artery
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Katritsis, D.G.
Pantos, I.
Korovesis, S.
Hadjipavlou, M.
Tzanalaridou, E.
Lockie, T.
Redwood, S.
Voridis, E.
Efstathopoulos, E.P.
Περιοδικό:
Coronary Artery Disease
Λέξεις-κλειδιά:
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
DOI:
10.1097/MCA.0b013e32832397fe
