Division of Cardiovascular Diseases, Mayo Clinic, Rochester Minnesota 55905, USA.
Catheter Cardiovasc Interv. 2012 Aug 1;80(2):304-9. doi: 10.1002/ccd.23425. Epub 2012 Mar 14.
To assess the anatomic characteristics of the left main coronary artery (LM), and the relation between anatomic and clinical factors and the LM bifurcation angle (BA) using a novel, three dimensional quantitative coronary angiography (3D QCA) software.
Percutaneous intervention of the LM is a therapeutic option in selected patients with coronary artery disease (CAD). The anatomic features of the LM and its BA are determinants of procedural success and clinical outcome. However, those features and the factors that may affect the LM BA have not been fully described.
The LM anatomy was evaluated from angiograms of 203 patients (age = 66 ± 11 years, 31% female) with and without LM CAD using 3D QCA analysis (IC-PRO, Paieon, Israel). LM size as well as the proximal BA (between LM and LCX) and the distal BA (between left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX)) were measured in end-diastole. Angiographic and clinical findings were also recorded.
133/203 patients (65%) had no LM CAD. 3D QCA analysis demonstrated significant variability in the anatomy of the normal LM, including the LM branch vessels (LAD, LCX) diameter, and the LM BA. Among the 70 patients with LM CAD, 44 had distal LM disease. Importantly, patients with distal LM CAD had narrower proximal BA and a wider distal BA. Multivariate analysis (adjusted for clinical and anatomic variables) identified female sex (P = 0.02), trifurcation anatomy (P = 0.009), age > 75 years (P = 0.0009), and LM length > 12 mm (P = 0.001) as independent associates of the proximal BA. Independent associates of the distal BA were: trifurcation anatomy (P = 0.001), LM length > 12 mm (P < 0.0001), age > 75 years (P = 0.004), and a history of coronary bypass surgery (P = 0.04).
The current study demonstrates significant variability in the anatomy of the LM. The LM BA differs between patients with and without distal LM CAD, and both anatomic and clinical factors may affect the LM BA. Our findings also emphasize the possible usefulness of 3D QCA in the assessment of the LM.
使用一种新的三维定量冠状动脉造影（3D QCA）软件评估左主干（LM）的解剖特征，以及解剖学因素与临床因素与 LM 分叉角度（BA）之间的关系。
经皮介入治疗 LM 是治疗特定冠心病（CAD）患者的一种治疗选择。LM 的解剖特征及其 BA 是决定手术成功和临床结局的因素。然而，这些特征以及可能影响 LM BA 的因素尚未得到充分描述。
使用 3D QCA 分析（IC-PRO，Paieon，以色列）评估 203 例（年龄=66±11 岁，31%为女性）有或无 LM CAD 的患者的 LM 解剖结构。在舒张末期测量 LM 大小以及近端 BA（LM 和 LCX 之间）和远端 BA（左前降支冠状动脉（LAD）和左回旋支冠状动脉（LCX）之间）。还记录了血管造影和临床发现。
203 例患者中有 133 例（65%）无 LM CAD。3D QCA 分析显示正常 LM 的解剖结构存在显著差异，包括 LM 分支血管（LAD、LCX）的直径和 LM BA。在 70 例 LM CAD 患者中，44 例为 LM 远端病变。重要的是，LM 远端 CAD 患者的近端 BA 较窄，远端 BA 较宽。多变量分析（调整了临床和解剖变量）确定女性（P=0.02）、三分叉解剖（P=0.009）、年龄>75 岁（P=0.0009）和 LM 长度>12mm（P=0.001）是近端 BA 的独立相关因素。远端 BA 的独立相关因素为：三分叉解剖（P=0.001）、LM 长度>12mm（P<0.0001）、年龄>75 岁（P=0.004）和冠状动脉旁路移植术史（P=0.04）。
本研究表明 LM 的解剖结构存在显著差异。LM BA 在有或无 LM 远端 CAD 的患者之间存在差异，解剖学和临床因素均可能影响 LM BA。我们的研究结果还强调了 3D QCA 在评估 LM 中的可能作用。
