Postmortem angiographic and pathologic-anatomic findings in coronary heart disease: a comparative study using planimetry
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Coronary angiography often underestimates the severity of coronary artery stenosis compared to postmortem examinations. This underestimation, particularly in critical blockages, impacts surgical decisions for coronary artery disease.
Area of Science:
- Cardiovascular Pathology
- Interventional Cardiology
- Medical Imaging
Background:
- Accurate assessment of coronary artery stenosis is crucial for guiding treatment decisions in patients with coronary artery disease.
- Existing literature presents conflicting findings regarding the concordance between angiographic and pathological evaluations of coronary artery stenosis.
Purpose of the Study:
- To quantitatively compare the accuracy of postmortem coronary angiography with detailed pathologic-anatomic measurements in assessing coronary artery stenosis.
- To identify discrepancies in stenosis grading and evaluate the implications for clinical practice, particularly regarding surgical interventions.
Main Methods:
- Postmortem examination of 26 human hearts with diagnosed coronary artery disease.
- Quantitative planimetric measurements of 203 coronary artery cross-sections.
- Comparison of morphometric data with pre-mortem coronary angiogram findings using a standardized scoring system.
Main Results:
- A highly significant difference (P < 0.001) was observed between angiographic and morphologic assessments of coronary artery stenosis.
- Angiography underestimated the degree of stenosis in 47% (96/203) of cases, overestimated in 9% (18/203), and was accurate in 44% (89/203).
- The tendency for underestimation was consistent across all major coronary arteries without statistically significant differences.
Conclusions:
- Postmortem coronary angiography frequently underestimates the true degree of coronary artery stenosis when compared to detailed morphologic analysis.
- This underestimation is particularly pronounced in critical stenoses (>60%) and has significant implications for the selection of patients eligible for coronary artery bypass grafting or other surgical interventions.
Abstract:
Comparisons of the results of angiographic and pathologic-anatomic estimations of the degree of coronary artery stenosis are rare and the findings contradictory. In the present study, postmortem examinations were carried out on 26 hearts with coronary artery disease. Quantitative planimetric measurements of 203 coronary artery cross-sections were performed and compared with the results of postmortem coronary angiograms. Using a score rating scale, a highly significant difference (P < 0.001) between the angiographic and morphologic findings was detected, with the degree of stenosis and underestimated angiographically in 96 of the 203 sections (47%), overestimated in 18 (9%), and correctly estimated in 89 (44%). The tendency to underestimation was equal in all of the coronary arteries (left anterior descending, circumflex, and right coronary arteries); there were no statistically significant differences (P < 0.20, P < 0.30, P < 0.10). The frequency of angiographic underestimation of the degree of morphologic stenosis--especially in critical stenoses of more than 60%)--has important implications in the assessment of whether coronary artery surgery is warranted.