Coronary artery spatial distribution of acute myocardial infarction occlusions
Coronary artery spatial distribution of acute myocardial infarction occlusions
复制标题
DOI：
10.1161/01.cir.0000135468.67850.f4
复制
发表时间：
2004-07-20
期刊：
影响因子：
37.8
通讯作者：
Kuntz, RE
中科院分区：
文献类型：
--
作者：
Wang, JC;Normand, SLT;Kuntz, RE
背景-急性冠状动脉闭塞导致ST段抬高心肌梗死(STEMI)的主要原因是动脉粥样硬化斑块的破裂。目前的“易损斑块”检测技术侧重于识别单个斑块，除了传统的降低危险因素外，没有明确的治疗计划。我们开发了急性冠状动脉闭塞分布的空间地图，以验证我们的假设，即斑块破裂并不是均匀地发生在整个冠脉树上。方法和结果-我们分析了连续208名在布里格姆妇女医院就诊的STEMI患者，并绘制了急性冠状动脉闭塞的位置图。这些闭塞并不均匀地分布于心外膜各主要冠状动脉，而倾向于聚集在各血管近1/3处(右冠状动脉，P=0.001；左前降支，P=0.003；左回旋支，P=0.001)。此外，Poisson回归分析显示，冠状动脉开口距离每增加10 mm，右冠状动脉急性闭塞的风险显著降低13%，左前降支减少30%，左回旋支减少26%。结论：导致STEMI的急性冠状动脉闭塞倾向于聚集在冠状动脉近1/3处可预测的“热点”。识别这些急性冠状动脉闭塞的高危区域将导致易损斑块检测技术和潜在的局部定向预防策略的未来进步。
Background-Acute coronary occlusions leading to ST-segment elevation myocardial infarctions (STEMIs) are due primarily to rupture of atherosclerotic plaques. Present "vulnerable plaque" detection technology focuses on identifying individual plaques with no clear therapeutic plan beyond conventional risk factor reduction. We developed a spatial map of the distribution of acute coronary occlusions to test our hypothesis that plaque ruptures do not occur uniformly throughout the coronary tree.Methods and Results-We analyzed 208 consecutive patients who presented to the Brigham and Women's Hospital with STEMI and mapped the location of the acute coronary occlusion. These occlusions were not uniformly distributed throughout each of the major epicardial coronary arteries but tended to cluster within the proximal third of each of the vessels (right coronary artery, P=0.001; left anterior descending artery, P=0.003; left circumflex artery, P=0.001). Furthermore, Poisson regression showed that for each 10-mm increase in distance from the ostium, the risk of an acute coronary occlusion was significantly decreased by 13% in the right coronary artery, 30% in the left anterior descending artery, and 26% in the left circumflex artery.Conclusions-Acute coronary occlusions leading to STEMI tend to cluster in predictable "hot spots" within the proximal third of the coronary arteries. Identification of these high-risk zones for acute coronary occlusions will lead to future advances in vulnerable plaque detection technology and potentially locally directed preventive strategies.