Localization of culprit lesions in coronary arteries of patients with ST-segment elevation myocardial infarctions: Relation to bifurcations and curvatures
Localization of culprit lesions in coronary arteries of patients with ST-segment elevation myocardial infarctions: Relation to bifurcations and curvatures
复制标题
DOI：
10.1016/j.ahj.2010.11.005
复制
发表时间：
2011-03-01
影响因子：
4.8
通讯作者：
Samady, Habib
中科院分区：
文献类型：
--
作者：
McDaniel, Michael C.;Galbraith, Erin M.;Samady, Habib
尽管ST段抬高型心肌梗死（STEMI）的罪犯病变集中在冠状动脉近端，但其与血流受到干扰的分叉和弯曲的关系尚不清楚。我们假设：（a）罪犯病变定位于分叉和弯曲的远端干扰流和（B）罪犯病变在左（LCA）和右冠状动脉（RCA）的分布和由此产生的梗死面积与分叉和弯曲的位置有关。结果79%的患者冠状动脉病变位于分叉处20 mm以内，与RCA相比，LCA更靠近分叉处（7.4 ± 7.3 vs 17.7 ± 14.8 mm，P < .0001）。在RCA罪犯病变中，45%位于大弯20 mm以内。与RCA相比，LCA中的罪犯病变位于更近端（24.4 ± 16.5 vs 44.7 ± 28.8 mm，P = .0003），并与肌酸激酶-MB峰值评估的较大心肌梗死相关（208 +/- 222 vs 140 +/- 153 ng/dL，P = .001）和肌钙蛋白I（59 +/- 62 vs 40 +/- 35 ng/dL，P = .0006），住院死亡率较高结论在STEMI患者中，罪犯病变经常位于分叉远端和已知发生干扰血流的主要弯曲附近。这支持了壁切应力在STEMI发病机制中的作用。(Am Heart J 2011;161：508-15.）
Background Although culprit lesions in ST-segment elevation myocardial infarction (STEMI) cluster in the proximal coronary arteries, their relationship to bifurcations and curvatures, where blood flow is disturbed, is unknown. We hypothesized that (a) culprit lesions localize to disturbed flow distal to bifurcations and curvatures and (b) the distribution of culprit lesions in the left (LCA) and right coronary arteries (RCA) and resulting infarct size are related to the location of bifurcations and curvatures.Methods Emory University's contribution to the National Cardiovascular Data Registry was queried for STEMIs. Using quantitative coronary angiography, the distances from the vessel ostium, major bifurcations, and major curvatures to the culprit lesion were measured in 385 patients.Results Culprit lesions were located within 20 mm of a bifurcation in 79% of patients and closer to the bifurcation in the LCA compared with the RCA (7.4 +/- 7.3 vs 17.7 +/- 14.8 mm, P < .0001). Of RCA culprit lesions, 45% were located within 20 mm of a major curvature. Compared with those in the RCA, culprit lesions in the LCA were located more proximally (24.4 +/- 16.5 vs 44.7 +/- 28.8 mm, P = .0003) and were associated with larger myocardial infarctions as assessed by peak creatine kinase-MB (208 +/- 222 vs 140 +/- 153 ng/dL, P = .001) and troponin I (59 +/- 62 vs 40 +/- 35 ng/dL, P = .0006) and with higher in-hospital mortality (5.2% vs 1.1%, P = .04).Conclusions In patients with STEMI, culprit lesions are frequently located immediately distal to bifurcations and in proximity to major curvatures where disturbed flow is known to occur. This supports the role of wall shear stress in the pathogenesis of STEMI. (Am Heart J 2011;161:508-15.)