Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with
M Louisa Antoni1, Kai-Hang Yiu, Jael Z Atary
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Vulnerable plaque in ST-segment elevation acute myocardial infarction most often occurs in the left anterior descending artery. Lesion location impacts cardiac enzyme levels and left ventricular function, highlighting the need to identify high-risk patients.
Area of Science:
- Cardiology
- Vascular Biology
- Biomedical Imaging
Background:
- Limited data exists on the distribution of vulnerable coronary artery lesions.
- Understanding lesion location is crucial for managing acute myocardial infarction (AMI).
Purpose of the Study:
- To determine the frequency and distribution of culprit lesions in ST-elevation myocardial infarction (STEMI) patients.
- To correlate culprit lesion location with infarct size.
Main Methods:
- Evaluation of 1533 consecutive STEMI patients undergoing primary percutaneous coronary intervention.
- Two-dimensional echocardiography performed within 48 hours of admission.
Main Results:
- Culprit lesions were most frequent in the left anterior descending (LAD) artery (45%), followed by the right coronary artery (RCA, 38%) and left circumflex (LCX) artery (14%).
- Proximal LAD and LCX lesions correlated with higher peak cardiac enzymes and worse left ventricular function compared to RCA lesions.
- Proximal LAD and LCX lesions were associated with worse left ventricular function.
Conclusions:
- Plaque rupture leading to AMI commonly affects proximal LAD and RCA segments.
- Culprit lesion location influences infarct size and clinical outcomes.
- Identifying vulnerable lesion distribution aids in risk stratification for acute coronary events.
Objectives:
Data regarding the distribution of vulnerable lesions in the coronary arteries are scarce. The aim was to evaluate the frequency and distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction. In addition, the location of culprit lesions was related to infarct size.
Methods:
Consecutive patients (N=1533, mean age 61±12 years) were evaluated. All patients were treated with primary percutaneous coronary intervention and underwent two-dimensional echocardiography less than 48 h after admission.
Results:
The majority of the culprit lesions were located in the left anterior descending coronary artery (LAD, 45%), followed by the right coronary artery (RCA, 38%), and left circumflex coronary artery (LCX, 14%). Subanalysis demonstrated that patients with a culprit lesion in the LAD and LCX had significantly higher-peak cardiac enzymes compared with patients with culprit lesions in the RCA. In addition, patients with proximal LAD and LCX lesions had significantly worse left ventricular function compared with patients with mid or distal lesions.
Conclusion:
Plaque rupture resulting in acute myocardial infarction is more likely to occur in the proximal parts of the LAD and RCA. In addition, the location of culprit lesions was related to infarct size. Therefore, knowledge of the distribution of vulnerable lesions is important for identifying patients at risk for acute coronary events.
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