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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Determination of vessel size: a putative framework to assess clinical outcome
Folkert W Asselbergs1, Lieuwe H Piers, Gillian A J Jessurun
1Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands. f.w.asselbergs@thorax.azg.nl
Insights
A small left anterior descending (LAD) coronary artery diameter (< or =2.5 mm) measured without vasodilator agents is an independent predictor of adverse cardiovascular events in patients undergoing initial diagnostic angiography.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Prognostic Biomarkers
Background:
- The prognostic significance of coronary artery diameter, particularly the left anterior descending (LAD) artery, without vasomotor stimuli is not well-established.
- A small reference vessel size is a known adverse prognostic factor in patients who have undergone revascularization procedures.
Purpose of the Study:
- To evaluate the predictive value of the proximal non-stenotic LAD diameter for cardiovascular events.
- To assess the prognostic implications of LAD diameter in patients undergoing their first diagnostic coronary angiogram without prior revascularization.
Main Methods:
- Quantitative coronary angiography was used to measure the proximal non-stenotic LAD diameter in 277 patients (mean age 57 years, 61% male) without prior nitrate administration.
- A small LAD was defined as a diameter less than or equal to 2.5 mm.
- Cardiovascular events included cardiac death, myocardial infarction, and unstable angina hospitalizations.
Main Results:
- Over a median follow-up of 47 months, 24 major cardiac events occurred.
- Patients with a small LAD (< or =2.5 mm) had significantly lower cumulative survival (hazard ratio 2.51, p=0.03).
- A LAD diameter <= 2.5 mm remained an independent predictor of cardiovascular events in multivariate analysis (hazard ratio 2.32, p=0.048), even after adjusting for age, gender, and coronary artery disease severity.
Conclusions:
- The diameter of the proximal non-stenotic LAD serves as an independent predictor of cardiovascular events.
- This finding is significant for patients undergoing their first diagnostic angiogram without prior revascularization.
Background:
Unknown is the predictive value of the coronary artery diameter without the administration of vasomotor stimuli. A small reference diameter of the target vessel has been demonstrated to be an adverse prognostic factor in patients undergoing revascularisation. The present study investigated the prognostic value of the proximal non-stenotic left anterior descending coronary artery (LAD) diameter in patients referred for a first diagnostic angiogram without a previous revascularisation.
Methods:
A total of 277 patients (mean age 57 year, 61% male) were eligible for analysis. The proximal non-stenotic diameter of the LAD was measured by quantitative coronary angiography without prior nitrate infusion. We defined a small LAD as a diameter < or =2.5 mm. Cardiovascular events were defined as cardiac death, myocardial infarction, and hospitalizations for unstable angina.
Results:
During a median follow-up of 47 months, 24 major cardiac events occurred. The cumulative survival for patients with a small LAD was significantly lower, than for patients with a large LAD (hazard ratio 2.51; 95% confidence interval 1.11-5.66, p=0.03). In the multivariate analysis, a LAD diameter < or =2.5 mm remained a significant predictor of cardiovascular events after adjustment for age, gender, and the presence of significant coronary artery disease (hazard ratio 2.32; 95% confidence interval 1.01-5.34, p=0.048).
Conclusion:
In patients referred for a first diagnostic angiogram without a previous revascularisation, the diameter of the proximal non-stenotic LAD is an independent predictor of cardiovascular events.
