Gibson C Michael, Kirtane Ajay J, Murphy Sabina A, Karha Juhana, Cannon Christopher P, Giugliano Robert P, Roe Mathew T, Harrington Robert A, Ohman E Magnus, Antman Elliott M
TIMI Study Group, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, USA.
J Thromb Thrombolysis. 2003 Jun;15(3):189-96. doi: 10.1023/B:THRO.0000011374.60110.bc.
Shorter distances from the coronary ostia to culprit lesions have been associated with a higher incidence of adverse outcomes in ST elevation acute myocardial infarction (STEMI). As drug-eluting stents are associated with low rates of restenosis and formation of a stable intima, we sought to develop a mathematical model to estimate how far down the coronary artery a drug-eluting stent would have to be placed to theoretically mitigate the risk of proximal plaque rupture.
Distances from the ostia to the end of the culprit lesions were planimetered in 1,914 patients from the TIMI 14, INTEGRITI, FASTER and ENTIRE/TIMI 23 trials.
The first 60 mm of the coronary artery contained 75% of STEMI culprit lesions. The median distance from the vessel ostium to the end of the culprit lesion was 43 mm (mean 50 +/- 34) and the relative distance from the vessel ostium to the end of the lesion was 29% (mean 33 +/- 17%) of the total culprit artery length. Diabetes was the only baseline clinical characteristic associated with a longer absolute distance to the end of the culprit lesion (46 mm vs. 43 mm, p = 0.03) as well as relative to total artery length (31% vs. 29%, p = 0.04). Median distances from the artery ostium to the end of the culprit lesion were shortest among the left anterior descending culprits (40 mm), followed by circumflex lesions (43 mm) and then right coronary artery lesions (47 mm, 3-way p < 0.0001).
The majority of culprit lesions in STEMI are contained within the proximal 30% of the major epicardial coronary arteries, but the distance varies depending upon which epicardial artery is involved. Cumulative distribution functions are presented to allow estimation of the percent of culprit lesions lying proximal to any given distance from the ostium to model the feasibility of prophylactic drug-eluting stenting to minimize the risk of subsequent proximal plaque rupture.
在ST段抬高型急性心肌梗死（STEMI）中，冠状动脉开口至罪犯病变的距离较短与不良结局的发生率较高相关。由于药物洗脱支架与再狭窄率低和稳定内膜形成有关，我们试图建立一个数学模型来估计药物洗脱支架在冠状动脉中需要放置多远才能从理论上降低近端斑块破裂的风险。
在TIMI 14、INTEGRITI、FASTER和ENTIRE/TIMI 23试验的1914例患者中，用求积仪测量从开口到罪犯病变末端的距离。
冠状动脉的前60mm包含了75%的STEMI罪犯病变。从血管开口到罪犯病变末端的中位数距离为43mm（平均50±34），从血管开口到病变末端的相对距离为罪犯动脉总长度的29%（平均33±17%）。糖尿病是与到罪犯病变末端的绝对距离较长（46mm对43mm，p = 0.03）以及相对于动脉总长度较长（31%对29%，p = 0.04）相关的唯一基线临床特征。从动脉开口到罪犯病变末端的中位数距离在左前降支罪犯病变中最短（40mm），其次是回旋支病变（43mm），然后是右冠状动脉病变（47mm，三组比较p < 0.0001）。
STEMI中的大多数罪犯病变位于心外膜主要冠状动脉的近端30%以内，但距离因受累的心外膜动脉不同而有所变化。给出累积分布函数以估计位于从开口起任何给定距离近端的罪犯病变百分比，从而模拟预防性药物洗脱支架置入以最小化后续近端斑块破裂风险的可行性。
