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

作者：Koo Bon Kwon; Lee Seung Pyo; Lee Ju Hee; Park Kyung Woo; Suh Jung Won; Cho Young Seok; Chung Woo Young; Doh Joon Hyung; Nam Chang Wook; Yu Cheol Woong; Lee Bong Ki; Vassilev Dobrin; Gil Robert; Lim Hong Seok; Tahk Seung Jea; Kim Hyo Soo^*

来源：JACC: Cardiovascular Interventions , 2012, 5(11): 1126-1132.

DOI：10.1016/j.jcin.2012.05.018

• bifurcation
• coronary disease
• electrocardiography
• physiology
• stenosis

Objectives This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions. %26lt;br%26gt;Background Discrepancy exists between stenosis severity and clinical outcomes in bifurcation lesions. However, its mechanism has not been fully evaluated yet. %26lt;br%26gt;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. %26lt;br%26gt;Results ST-segment elevation was more frequent during LAD occlusion (92%) than during diagonal branch occlusion (37%) (p %26lt; 0.001). Pain score was also higher with the occlusion of LAD than with the diagonal branch (p %26lt; 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 %26lt; 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 %26lt; 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 (%26gt;= 2.5 mm) to determine the presence of ST-segment elevation were 48% and 72%, respectively. %26lt;br%26gt;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.

• 出版日期2012-11