Predictive value of the angiographic anatomic characteristics of the left main coronary on acute myocardial infarction in patients with coronary atherosclerosis.

BACKGROUND

The coronary artery anatomic morphology is a critical determining factor for intracoronary hemodynamics and atherosclerotic lesion formation. This study aimed to test whether the anatomic characteristics of the left main (LM) coronary artery can predict acute myocardial infarction in the left coronary artery (AMI-LC).

METHODS

We retrospectively analyzed the clinical and coronary angiographic data of 1825 consecutive patients who underwent coronary angiography. Among them, 149 presented with AMI-LC, and 1118 had coronary artery stenosis >50%, but were without complete coronary occlusion. The length and diameter of the LM and the angle between the left anterior descending (LAD) or circumflex artery and the LM were determined by quantitative coronary angiography.

RESULTS

The AMI-LC patients had a shorter LM length (11.6 ± 2.1 mm, 14.3 ± 1.9 mm, and 15.8 ± 5.9 mm, respectively; P<.001) and a larger angle between the LAD and the LM (127 ± 27°, 115 ± 29°, and 119 ± 32°, respectively; P<.001) than the coronary artery disease (CAD) patients without complete coronary occlusion and normal subjects. The patients were divided into short-LM (3.65-10.95 mm), medium-LM (10.96-15.24 mm), and long-LM (15.25-37.84 mm) groups based on the length of the LM. The incidence of AMI-LC in the short-LM group was significantly higher than in the other two groups (14.4%, 7.4%, and 4.2%, respectively; P=.001). Multiple logistic regression analysis showed that LM length and the angle between the LAD and the LM were independent predictors of the occurrence of AMI-LC. The receiver operating characteristic curve test showed that their combination can predict AMI-LC with a sensitivity of 72% and a specificity of 86%.

CONCLUSION

Short LM length and a large angle between the LAD and LM may be independent risk factors for AMI-LC in CAD patients.