The Relationship between Coronary Artery Movement Type andStenosis Severity with Acute Myocardial Infarction
Samad Ghaffari1, Siamak Erfanparast, Ahmad Separham
1Cardiovascular Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
Insights
Most myocardial infarctions (MI) involve coronary artery lesions with at least 50% stenosis. These culprit lesions are often found in coronary segments exhibiting a compression movement pattern, suggesting a link between plaque severity, movement, and heart attack.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Controversy exists regarding the severity of coronary artery stenosis leading to myocardial infarction (MI).
- Historical data suggested mild stenosis, while recent studies implicate hemodynamically significant stenosis.
- Coronary artery movement (CAM) and associated mechanical stress may contribute to plaque rupture.
Purpose of the Study:
- To evaluate the severity of atherosclerotic plaques causing MI.
- To identify common coronary artery movement (CAM) patterns in segments with culprit lesions.
Main Methods:
- A cross-sectional study of 162 patients with acute ST-segment myocardial infarction (STEMI) undergoing coronary angiography.
- Evaluation of the relationship between CAM type, stenosis severity (moderate: >50%, severe: ≥70%), and acute MI.
- Assessment of three CAM patterns: compression, bending, and displacement in culprit lesion segments.
Main Results:
- 86% of infarct-related lesions (IRLs) showed at least moderate stenosis, and 67% had severe stenosis.
- All anterior STEMI cases involving the Left Anterior Descending (LAD) artery had >50% stenosis.
- The compression pattern was significantly more prevalent in LAD, RCA, Diagonal, and OM branches.
Conclusions:
- The majority of lesions causing MI exhibit at least 50% diameter stenosis.
- Coronary segments with a compression movement pattern are frequently associated with MI-causing lesions.
Introduction:
The severity of coronary artery stenosis which leads to myocardial infarction (MI) has been a matter of controversy. Historical data are in favor of mild luminal stenosis (<50% diameter stenosis) while recent studies suggest hemodynamically-significant coronary stenosis as the main substrate for subsequent MI. Also, mechanical stress resulted from coronary artery movement (CAM) may be responsible for plaques rupture. In this study, we evaluated the severity of plaques leading to MI and common CAM patterns in the involved coronary segments.
Methods:
In a cross-sectional descriptive-analytical study, on patients with acute ST-segment myocardial infarction (STEMI) undergoing coronary angiography, the relationship between coronary artery movement type and stenosis severity with acute MI was evaluated. Lesions with stenosis diameter greater than 50 percent were defined as moderate and those equal or higher than 70% were defined as severe stenosis. Three different patterns of coronary artery motion including compression, bending and displacement types were evaluated in segments with culprit lesion.
Results:
One hundred and sixty two patients were enrolled. Ninety patients (55.6%) were male and 72 (44.4%) were female. Mean age of the patients was 60.56±13.43 years. In terms of Infarct related lesions (IRLs), 86% of the cases had at least moderate stenosis and in 67%, severe stenosis was present. More than 50% stenosis was found in all patients with anterior STEMI involving LAD. Among three types of coronary motion patterns, compression pattern was significantly higher in LAD (P<0.001), RCA (P<0.001), Diagonal artery (P<0.001) and OM branch (P=0.044), but not in proper LCX (P=0.307).
Conclusion:
Most of the lesions leading to myocardial infarction have a diameter stenosis of at least 50% and mainly are located in the coronary segments with compression movement pattern.
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