El Zayat Ahmed, Eldeeb Mohey, Gad Marwa, Ibrahim Ismail M
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt.
J Saudi Heart Assoc. 2021 Apr 19;33(1):35-40. doi: 10.37616/2212-5043.1238. eCollection 2021.
Coronary artery anatomy frequently affects location of atherosclerotic plaques and subsequent culprit lesions. We sought to clarify whether presence or absence of Ramus Intermedius coronary artery (RI) would affect location of culprit lesions in acute left circumflex (LCX) coronary artery occlusion.
The study included 180 patients, 100 with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) and 80 with ST elevation myocardial infarction (STEMI). All culprit lesions were located in the LCX coronary artery. RI group included 45 patients and the No RI group included 135 patients.
Culprit LCX lesions were similarly located at a comparable distance from LCX ostium in both groups and the presence of RI was not associated with significantly more proximally located culprit LCX lesions (34.7 ± 15.2 mm compared to 30.8 ± 17.9 mm respectively, p > 0.05). The frequency distribution of culprit lesions' distance from LCX ostium showed no significant difference between both groups in any of the segments studied (10 mm each). There was no significant difference between both groups regarding markers of myocardial necrosis size as cardiac biomarkers (peak cardiac troponin-T 1077.4 ± 361.2 pg/dl vs 926 ± 462.2 pg/dl respectively, p = 0.13), (peak creatine kinase-MB 232.2 ± 81 ng/dl vs 194.7 ± 99.2 ng/dl respectively, p = 0.07) or left ventricular ejection fraction (EF 46.3 ± 6.3% vs 48.3 ± 8.3% respectively, p = 0.76).
Presence of RI coronary artery, as an additional flow divider, may not be associated with more proximal culprit lesions, compared to its absence, in cases of acute LCX coronary artery occlusion. Possible underlying pathophysiologic mechanisms remain to be clarified.
冠状动脉解剖结构常常影响动脉粥样硬化斑块的位置以及随后的罪犯病变。我们试图阐明冠状动脉中间支（RI）的有无是否会影响急性左旋支（LCX）冠状动脉闭塞时罪犯病变的位置。
该研究纳入了180例患者，其中100例诊断为非ST段抬高型心肌梗死（NSTEMI），80例诊断为ST段抬高型心肌梗死（STEMI）。所有罪犯病变均位于LCX冠状动脉。RI组包括45例患者，非RI组包括135例患者。
两组中罪犯LCX病变在距LCX开口处相似的距离处，且RI的存在与罪犯LCX病变更靠近近端并无显著关联（分别为34.7±15.2mm和30.8±17.9mm，p>0.05）。在研究的任何节段（每段10mm）中，罪犯病变距LCX开口处的频率分布在两组之间均无显著差异。两组在心肌坏死大小标志物方面无显著差异，如心脏生物标志物（峰值心肌肌钙蛋白-T分别为1077.4±361.2pg/dl和926±462.2pg/dl，p=0.13）、（峰值肌酸激酶-MB分别为232.2±81ng/dl和194.7±99.2ng/dl，p=0.07）或左心室射血分数（EF分别为46.3±6.3%和48.3±8.3%，p=0.76）。
在急性LCX冠状动脉闭塞的情况下，作为额外分流器的RI冠状动脉的存在与不存在相比，可能与更靠近近端的罪犯病变无关。潜在的病理生理机制仍有待阐明。
