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CLINICAL STUDIES

Geometric features of coronary artery lesions favoring acute occlusion and myocardial infarction: a quantitative angiographic study

Francois Ledru, MD^a, Pierre Théroux, MD, Jacques Lespérance, MD, Jean Laurier, MSc, Pierre Ducimetière, PhD^*, Jean-L.éon Guermonprez, MD^a, Benoit Diébold, MD, PhD^a and Didier Blanchard, MD^a

^a Department of Cardiology, Broussais Hospital, Paris, France
^* INSERM Unit 258, Broussais Hospital, Paris, France
Department of Medecine, Montreal Heart Institute, Montreal, Canada
Department of Radiology, Montreal Heart Institute, Montreal, Canada

Manuscript received June 5, 1998; revised manuscript received October 19, 1998, accepted January 5, 1999.

Reprint requests and correspondence: Dr. Francois Ledru, Département de Cardiologie, Hopital Broussais, 96 rue Didot, 75014 Paris, France
francois.ledru{at}brs.ap-hop-paris.fr

OBJECTIVES

We sought to identify the angiographic predictors of a future infarction, to study their interaction with time to infarction, patient risk factors and medications, and to evaluate their clinical utility for risk stratification.

BACKGROUND

Identification of coronary lesions at risk of acute occlusion remains challenging. Stenosis severity is poorly predictive but other stenosis descriptors might be better predictors.

METHODS

Eighty-four patients with an acute myocardial infarction and a coronary angiogram performed within the preceding 36 months (baseline angiogram), and after infarction were selected. All coronary stenoses (from 10% to 95% lumen diameter reduction) at baseline angiogram were analyzed by computer-assisted quantification. Each of the 84 lesions responsible for the infarction (culprit) was compared with the nonculprit stenoses (controls) in the same patient.

RESULTS

Culprit lesions were more symmetrical (symmetry index +15%; p < 0.001), had steeper outflow angles (maximal angle +4°; p < 0.001), were more severe (percent stenosis +5%; p = 0.001) and longer (+1.5 mm, p = 0.01) than controls. The symmetry index and the outflow angles were the two independent predictors of infarction at three-year follow-up. Stenosis severity predicted only infarctions occurring within 1 year after angiography. In moderately severe stenoses (40% to 70% stenosis), stratification using the symmetry index and outflow angles accurately predicted lesions remaining free of occlusion and infarction at three-year follow-up.

CONCLUSIONS

Better characterization of stenosis geometry might help to understand the pathophysiologic mechanisms triggering coronary occlusion and to stratify patients for improved care.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CMS = Coronary Measurement System   ECG = electrocardiogram   IRL = infarct-related lesion   PS = percent lumen diameter stenosis   QCA = quantitative coronary analysis   SIS = stenoses of intermediate severity   TIMI = Thrombolysis In Myocardial Infarction

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