계명대학교 의학도서관 Repository

Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Metadata Downloads
Author(s)
Bon-Kwon KooSeung-Pyo LeeJu-Hee LeeKyung-Woo ParkJung-Won SuhYoung-Seok ChoWoo-Young ChungJoon-Hyung DohChang-Wook NamCheol Woong YuBong-Ki LeeDobrin VassilevRobert GilHong-Seok LimSeung-Jea TahkHyo-Soo Kim
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC: Cardiovascular Interventions
Issued Date
2012
Volume
5
Issue
11
Keyword
bifurcationcoronary diseaseelectrocardiographyphysiologystenosis
Abstract
Objectives:

This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions.


Background:

Discrepancy exists between stenosis severity and clinical outcomes in bifurcation lesions. However, its mechanism has not been fully evaluated yet.


Methods:

Sixty-five patients with left anterior descending coronary artery (LAD) bifurcation lesions were prospectively enrolled. Chest pain and 12-lead electrocardiogram were assessed after 1-min occlusion of coronary flow and coronary wedge pressure (Pw) was measured using a pressure wire.


Results:

ST-segment elevation was more frequent during LAD occlusion (92%) than during diagonal branch occlusion (37%) (p < 0.001). Pain score was also higher with the occlusion of LAD than with the diagonal branch (p < 0.001). However, both Pw and Pw/aortic pressure (Pa) were lower in the LAD than in diagonal branches (Pw: 21.0 ± 6.5 vs. 26.7 ± 9.4, p < 0.0001; Pw/Pa: 0.22 ± 0.07 vs. 0.27 ± 0.08, p = 0.001). The corrected QT interval was prolonged with LAD occlusion (435.0 ± 39.6 ms to 454.0 ± 45.4 ms, p < 0.0001) but not with diagonal branch occlusion. There was no difference in vessel size between the diagonal branches with and without ST-segment elevation during occlusion. Positive and negative predictive values of vessel size (≥2.5 mm) to determine the presence of ST-segment elevation were 48% and 72%, respectively.


Conclusions:

Diagonal branch occlusion caused fewer anginas, less electrocardiogram change, less arrhythmogenic potential, and higher Pw than did a LAD occlusion. These differences seem to be the main mechanism explaining why aggressive treatment for side branches has not translated into clinical benefit in coronary bifurcation lesions.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine
Citation
Bon-Kwon Koo et al. (2012). Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions. JACC: Cardiovascular Interventions, 5(11), 1126–1132. doi: 10.1016/j.jcin.2012.05.018
Type
Article
ISSN
1936-8798
DOI
10.1016/j.jcin.2012.05.018
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/33901
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
공개 및 라이선스
  • 공개 구분공개
파일 목록

Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.