Department of Cardiology, University of Menoufia, Shebin Alkoum, Egypt. Email:
Department of Cardiology, University of Menoufia, Shebin Alkoum, Egypt.
Cardiovasc J Afr. 2023;34(2):93-97. doi: 10.5830/CVJA-2022-031. Epub 2022 Aug 17.
The aim of this study was to evaluate the association between the left main coronary artery (LM) bifurcation angle and the severity of the proximal left anterior descending coronary artery (LAD) stenosis.
Two hundred patients with suspected coronary artery disease who had coronary angiography were included in this observational study. The severity of coronary artery stenosis was analysed using quantitative coronary angiography software (QCA analysis). The LM-LAD and LAD-left circumflex artery (LCX) angles were measured using software (IC MEASURE) in two-dimensional axial images.
The patients were divided into two groups. The first group included 100 patients with significant proximal LAD stenosis (≥ 50%) and the second, those with LAD stenosis < 50% (100 patients). Patients with significant proximal LAD stenosis were older and had a higher frequency of diabetes mellitus, and higher serum creatinine and low-density lipoprotein levels than those with non-significant LAD stenosis. The LM-LAD and LAD-LCX angles in patients with significant proximal LAD stenosis were wider than in patients with non-significant LAD stenosis ( < 0.001). The cut-off value of 42° of the LM-LAD angle had a sensitivity of 73% and specificity of 70% to predict significant proximal LAD stenosis. The cut-off value of 68° of the LAD-LCX angle had a sensitivity of 68% and specificity of 62% to predict significant proximal LAD disease. In a multivariate logistic regression analysis, LM-LAD and LAD-LCX angles were independent factors for the development of significant proximal LAD stenosis.
Wider LM-LAD and LAD-LCX angles were associated with the severity of proximal LAD disease. Preventative measures and close follow up are needed in such cases to improve their cardiovascular outcome.
本研究旨在评估左主干冠状动脉（LM）分叉角与左前降支近段狭窄严重程度之间的关系。
本观察性研究纳入了 200 例疑似冠心病且接受冠状动脉造影的患者。使用定量冠状动脉造影软件（QCA 分析）分析冠状动脉狭窄程度。使用二维轴向图像中的软件（IC MEASURE）测量 LM-LAD 和 LAD-回旋支（LCX）角度。
患者分为两组。第一组包括 100 例左前降支近段狭窄≥50%的患者，第二组包括 100 例左前降支狭窄<50%的患者。与狭窄程度不显著的左前降支相比，狭窄程度显著的左前降支患者年龄更大，糖尿病发病率更高，血清肌酐和低密度脂蛋白水平更高。左前降支狭窄程度显著的患者 LM-LAD 和 LAD-LCX 角度大于狭窄程度不显著的患者（<0.001）。LM-LAD 角度 42°的截断值预测左前降支近段狭窄的敏感性为 73%，特异性为 70%。LAD-LCX 角度 68°的截断值预测左前降支近端病变的敏感性为 68%，特异性为 62%。在多变量逻辑回归分析中，LM-LAD 和 LAD-LCX 角度是左前降支近段狭窄严重程度的独立因素。
LM-LAD 和 LAD-LCX 角度较宽与左前降支近段病变严重程度相关。在这种情况下需要采取预防措施并密切随访，以改善其心血管预后。
