Three-dimensional analysis of vulnerable segments in the left anterior descending artery

Coron Artery Dis. 2009 May;20(3):199-206. doi: 10.1097/MCA.0b013e32832397fe.


Objectives: Analysis of conventional angiograms has suggested that specific anatomic parameters of particular segments of a coronary artery render them prone to vulnerable plaque development, plaque rupture, and consequent thrombosis. This study aimed at performing a three-dimensional analysis of recanalized left anterior descending (LAD) coronary arteries in patients who had suffered an anterior ST-elevation myocardial infarction (STEMI).

Methods: Coronary angiograms of 76 consecutive patients with an anterior STEMI and a recanalized LAD were reconstructed in the three-dimensional space, and compared with angiograms of 76 patients with stable coronary artery disease (SCAD) and significant LAD stenosis.

Results: In both groups the majority of lesions occurred between 20 and 40 mm (P=0.745), but the number of lesions beyond 60 mm from the ostium was significantly higher in SCAD compared with STEMI (P=0.045). Culprit lesions were statistically significantly longer in patients with STEMI compared with SCAD (18.3+/-7.5 vs. 12.7+/-6.2 mm, P<0.001). Cut-off point analysis indicated a lesion length of >or=12.5 mm as discriminating threshold between SCAD and STEMI (sensitivity 79% and specificity 63%). Bifurcation branches on the culprit lesion were seen in 79% of the patients with STEMI and 58% of those with SCAD (P=0.026). Lesion angulation was significantly sharper in STEMI compared with SCAD patients in diastole (155+/-15 vs. 160+/-14 degrees, P=0.037). Multiple logistic regression model including these parameters had a high discriminating ability with c-statistic 0.78 (95% confidence intervals: 0.71-0.86), sensitivity 72.4%, and specificity 75%.

Conclusion: Specific anatomic characteristics of LAD segments predispose to development of plaque rupture and thrombosis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Angiography*
  • Coronary Stenosis / complications
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Thrombosis / diagnostic imaging*
  • Coronary Thrombosis / etiology
  • Female
  • Humans
  • Imaging, Three-Dimensional*
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Cardiovascular
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / etiology
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted*
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index