Published online before print July 12, 2004, doi: 10.1161/01.CIR.0000135468.67850.F4
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:278-284.)
© 2004 American Heart Association, Inc.
Original Articles |
Coronary Artery Spatial Distribution of Acute Myocardial Infarction Occlusions
From the Divisions of Clinical Biometrics and Cardiovascular Medicine, Brigham and Women’s Hospital, and Harvard Medical School (J.C.W., L.M., R.E.K.), and the Department of Health Care Policy, Harvard Medical School and the Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass.
Correspondence to Richard Kuntz, MD, MSc, BC 3-012N, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02116. E-mail rkuntz{at}partners.org
Received January 18, 2004; revision received April 1, 2004; accepted April 5, 2004.
Background— Acute coronary occlusions leading to ST-segment elevation myocardial infarctions (STEMIs) are due primarily to rupture of atherosclerotic plaques. Present "vulnerable plaque" detection technology focuses on identifying individual plaques with no clear therapeutic plan beyond conventional risk factor reduction. We developed a spatial map of the distribution of acute coronary occlusions to test our hypothesis that plaque ruptures do not occur uniformly throughout the coronary tree.
Methods and Results— We analyzed 208 consecutive patients who presented to the Brigham and Women’s Hospital with STEMI and mapped the location of the acute coronary occlusion. These occlusions were not uniformly distributed throughout each of the major epicardial coronary arteries but tended to cluster within the proximal third of each of the vessels (right coronary artery, P=0.001; left anterior descending artery, P=0.003; left circumflex artery, P=0.001). Furthermore, Poisson regression showed that for each 10-mm increase in distance from the ostium, the risk of an acute coronary occlusion was significantly decreased by 13% in the right coronary artery, 30% in the left anterior descending artery, and 26% in the left circumflex artery.
Conclusions— Acute coronary occlusions leading to STEMI tend to cluster in predictable "hot spots" within the proximal third of the coronary arteries. Identification of these high-risk zones for acute coronary occlusions will lead to future advances in vulnerable plaque detection technology and potentially locally directed preventive strategies.
Key Words: coronary disease • myocardial infarction • plaque
This article has been cited by other articles:
 |
|
 |
|
  T. P. Carrigan, D. Nair, P. Schoenhagen, R. J. Curtin, Z. B. Popovic, S. Halliburton, S. Kuzmiak, R. D. White, S. D. Flamm, and M. Y. Desai Prognostic utility of 64-slice computed tomography in patients with suspected but no documented coronary artery disease Eur. Heart J., February 1, 2009; 30(3): 362 - 371. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Y. Lee, G. S. Mintz, S.-Y. Kim, Y. J. Hong, S. W. Kim, T. Okabe, A. D. Pichard, L. F. Satler, K. M. Kent, W. O. Suddath, et al. Attenuated Plaque Detected by Intravascular Ultrasound: Clinical, Angiographic, and Morphologic Features and Post-Percutaneous Coronary Intervention Complications in Patients With Acute Coronary Syndromes J. Am. Coll. Cardiol. Intv., January 1, 2009; 2(1): 65 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. F. Langer, R. Haubner, B. J. Pichler, and M. Gawaz Radionuclide imaging a molecular key to the atherosclerotic plaque. J. Am. Coll. Cardiol., July 1, 2008; 52(1): 1 - 12. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Ambrose In Search of the "vulnerable plaque": can it be localized and will focal regional therapy ever be an option for cardiac prevention? J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1539 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dalager, W. P. Paaske, I. Bayer Kristensen, J. Marsvin Laurberg, and E. Falk Artery-Related Differences in Atherosclerosis Expression: Implications for Atherogenesis and Dynamics in Intima-Media Thickness Stroke, October 1, 2007; 38(10): 2698 - 2705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Cheruvu, A. V. Finn, C. Gardner, J. Caplan, J. Goldstein, G. W. Stone, R. Virmani, and J. E. Muller Frequency and Distribution of Thin-Cap Fibroatheroma and Ruptured Plaques in Human Coronary Arteries: A Pathologic Study J. Am. Coll. Cardiol., September 4, 2007; 50(10): 940 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Konig and V. Klauss Virtual histology Heart, August 1, 2007; 93(8): 977 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Mehta, J. R. McCrary, A. D. Frutkin, W. J.S. Dolla, and S. P. Marso Intravascular ultrasound radiofrequency analysis of coronary atherosclerosis: an emerging technology for the assessment of vulnerable plaque Eur. Heart J., June 1, 2007; 28(11): 1283 - 1288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Moses, G. W. Stone, E. Nikolsky, G. S. Mintz, G. Dangas, E. Grube, S. G. Ellis, A. J. Lansky, G. Weisz, M. Fahy, et al. Drug-Eluting Stents in the Treatment of Intermediate Lesions: Pooled Analysis From Four Randomized Trials J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2164 - 2171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Jaffer, P. Libby, and R. Weissleder Molecular and Cellular Imaging of Atherosclerosis: Emerging Applications J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1328 - 1338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Valgimigli, G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, P. Malagutti, E. Regar, P. de Jaegere, P. de Feyter, and P. W. Serruys Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans Eur. Heart J., March 2, 2006; 27(6): 655 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Baim, L. Mauri, and D. C. Cutlip Drug-Eluting Stenting for Unprotected Left Main Coronary Artery Disease: Are We Ready to Replace Bypass Surgery? J. Am. Coll. Cardiol., February 21, 2006; 47(4): 878 - 881. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, J. Wentzel, M. Valgimigli, K. Tsuchida, W. van der Giessen, P. de Jaegere, E. Regar, P. J. de Feyter, and P. W. Serruys Plaque Composition and its Relationship With Acknowledged Shear Stress Patterns in Coronary Arteries J. Am. Coll. Cardiol., February 21, 2006; 47(4): 884 - 885. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Rodriguez-Granillo, H. M. Garcia-Garcia, E. P. Mc Fadden, M. Valgimigli, J. Aoki, P. de Feyter, and P. W. Serruys In Vivo Intravascular Ultrasound-Derived Thin-Cap Fibroatheroma Detection Using Ultrasound Radiofrequency Data Analysis J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2038 - 2042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Dudek, W. Mielecki, A. Dziewierz, J. Legutko, and J. S. Dubiel The role of thrombectomy and embolic protection devices Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I15 - I20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-K. Hong, G. S. Mintz, C. W. Lee, B.-K. Lee, T.-H. Yang, Y.-H. Kim, J.-M. Song, K.-H. Han, D.-H. Kang, S.-S. Cheong, et al. The Site of Plaque Rupture in Native Coronary Arteries: A Three-Vessel Intravascular Ultrasound Analysis J. Am. Coll. Cardiol., July 19, 2005; 46(2): 261 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Abaci, R. E. Kuntz, L. Mauri, J. C. Wang, and S.-L. T. Normand Letter Regarding Article by Wang et al, "Coronary Artery Spatial Distribution of Acute Myocardial Infarction Occlusions" * Response Circulation, May 31, 2005; 111(21): e369 - e369. [Full Text] [PDF]
|
|