Katritsis Demosthenes G, Efstathopoulos Efstathios P, Pantos Ioannis, Tzanalaridou Efthalia, De Waha Antoinette, Siontis George C M, Toutouzas Konstantinos, Redwood Simon, Kastrati Adnan, Stefanadis Christodoulos
Department of Cardiology, Athens Euroclinic, Athens, Greece.
Coron Artery Dis. 2011 Aug;22(5):345-51. doi: 10.1097/MCA.0b013e3283471f95.
To derive a model for the identification of left anterior descending (LAD) coronary artery stenoses predisposed to plaque rupture and thrombosis.
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).
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)].
Specific anatomic characteristics of LAD segments associated with STEMI can be identified on coronary angiograms and assist the risk stratification of coronary stenoses.
推导一种用于识别易发生斑块破裂和血栓形成的左前降支（LAD）冠状动脉狭窄的模型。
对186例连续的前壁ST段抬高型心肌梗死（STEMI）且LAD再通的患者（原始样本）的冠状动脉造影进行三维空间重建。将罪犯病变与同一患者的293处稳定的LAD冠状动脉狭窄进行比较。推导并在随后的50例STEMI患者和50例稳定病变患者（验证样本）中验证了一种预测血栓形成高概率狭窄的模型。
大多数罪犯病变发生在距LAD开口20至40毫米之间，而大多数稳定病变位于距离超过60毫米处（P<0.001）。罪犯病变在统计学上明显长于稳定病变（23.2±10.4毫米对14.7±7.2毫米；P<0.001）。与稳定病变（41.3%，P<0.001）相比，罪犯病变上的分叉明显更频繁（86.6%）。罪犯病变的病变角度明显更陡，呈对称性，而稳定病变相对于局部血管曲率位于血管内壁。通过在多元回归模型中使用这些参数开发了一种简单的加法工具。所提出指标的鉴别能力在原始样本[受试者操作特征曲线下面积：0.88（95%置信区间：0.85 - 0.91）]和验证样本[受试者操作特征曲线下面积：0.69（95%置信区间：0.59 - 0.78）]中均较高。
在冠状动脉造影上可识别与STEMI相关的LAD节段的特定解剖特征，并有助于冠状动脉狭窄的风险分层。
