Localization of culprit lesions in coronary arteries of patients with ST-segment elevation myocardial infarctions: Relation to bifurcations and curvatures

• Published in: The American heart journal Vol. 161; no. 3; pp. 508 - 515
• Main Authors: McDaniel, Michael C., MD, Galbraith, Erin M., MD, Jeroudi, Ahmad M., MD, Kashlan, Omar R., MD, Eshtehardi, Parham, MD, Suo, Jin, PhD, Dhawan, Saurabh, MD, Voeltz, Michele, MD, Devireddy, Chandan, MD, Oshinski, John, PhD, Harrison, David G., MD, Giddens, Don P., PhD, Samady, Habib, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Mosby; Elsevier Limited
• Subjects: Acute Coronary Syndrome - pathology; Aged; Atherosclerosis; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Angiography; Coronary heart disease; Coronary vessels; Coronary Vessels - pathology; Demographics; Female; Heart; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Molecular weight; Mortality; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Plaque, Atherosclerotic - pathology; Plaque, Atherosclerotic - physiopathology; Regional Blood Flow; Human; Myocardial infarction; Coronary artery; Bifurcation; Patient; Cardiovascular disease; Coronary heart disease; Myocardial disease; ST elevation; Circulatory system; Lesion; Cardiology; Localization; Curvature
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.11.005

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.