Anatomic characteristics of culprit sites in acute coronary syndromes

J Interv Cardiol. 2008 Apr;21(2):140-50. doi: 10.1111/j.1540-8183.2007.00339.x. Epub 2008 Feb 28.


Background: A detailed analysis of the anatomic relationships of the site of culprit lesions that have resulted in acute coronary syndromes (ACS) has not been reported.

Methods: Coronary angiograms of consecutive patients who presented with ACS were analyzed according to multiple anatomic criteria.

Results: In left anterior descending artery (LAD) (n = 85), 85% of culprit lesions were located in the first 40 mm from the ostium. The presence of angulation on the lesion increased the risk of an ACS 1.92 times (95% confidence interval [CI] 1.9-3.07), and the presence of bifurcation after the lesion increased the risk 1.65 times (95% CI 1.04-2.62). Angulated lesions located within the first 40 mm from the ostium and before a bifurcation presented an 11-fold increased risk for an ACS. In right coronary artery (RCA) (n = 58), the risk of plaque rupture was almost 2.5 times higher in lesions located between 10 and 50 mm from the ostium compared to those located in 90-130 mm (relative risk [RR] 2.38, 95% CI 1.25-4.56). In left circumflex (LCx) (n = 40), the risk of plaque rupture was almost 4.5 and 5 times higher in the first 20 mm, and between 20 and 40 mm from the ostium, respectively, compared to 60 and 80 mm (relative risk [RR] 4.58, 95% CI 1.01-20.68 for 0-20 mm, and RR 4.95, 95% CI 1.14-21.47 for 20-40 mm) after adjustment for the presence of curve on the lesion. The presence of lesion angulation increased the risk of plaque rupture almost three times (RR 3.22, 95% CI 1.49-6.93).

Conclusion: Specific anatomic features of the coronary arteries predispose to development and/or subsequent rupture of vulnerable plaques.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / pathology
  • Coronary Angiography*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis
  • Coronary Vessels / pathology*
  • Databases as Topic
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Risk
  • Risk Assessment
  • Risk Factors
  • Rupture