The compression type of coronary artery motion in patients with ST-segment elevation acute myocardial infarction and normal controls: a case-control study
© O'Loughlin et al; licensee BioMed Central Ltd. 2011
Received: 23 September 2010
Accepted: 7 March 2011
Published: 7 March 2011
Prediction of the location of culprit lesions responsible for ST-segment elevation myocardial infarctions may allow for prevention of these events. A retrospective analysis of coronary artery motion (CAM) was performed on coronary angiograms of 20 patients who subsequently had ST-segment elevation myocardial infarction treated by primary or rescue angioplasty and an equal number of age and sex matched controls with normal angiograms.
There was no statistically significant difference between the frequency of CAM types of the ST-segment elevation acute myocardial infarction and control patients (p = 0.97). The compression type of CAM is more frequent in the proximal and mid segments of all three coronary arteries. No statistically significant difference was found when the frequency of the compression type of CAM was compared between the ST-segment elevation acute myocardial infarction and control patients for the individual coronary artery segments (p = 0.59).
The proportion of the compression type of coronary artery motion for individual artery segments is not different between patients who have subsequent ST-segment elevation myocardial infarctions and normal controls.
The three-dimensional motion of the heart is characterized by rotation (around the centre of gravity), radial displacement (towards or away from the center of gravity), and translational motion (displacement parallel to its long axis). The total translational motion of the left ventricle is on average 2.2 cm and is such that motion occurs most at the base and least at the apex of the heart.
Motion of individual segments of coronary arteries reflects the motion of the underlying myocardium. The classification system for different patterns of coronary artery motion (CAM) used in this study is derived from a system where CAM was classified into 10 patterns, which were grouped into 3 types: (1) compression type: the length of the arterial segment is shortened without vertical deviation of the artery; (2) displacement type: the location of the coronary artery shifts without change of the length or shape of the arterial segment; and (3) bend type: the coronary artery flexes into a curve.
The compression type of CAM for individual artery segments is associated with stenosis and is a predictor of segments containing the culprit lesion responsible for ST-segment elevation myocardial infarctions (STEMIs). The compression type of CAM has recently been shown to be strongly associated with segments containing the culprit lesion in STEMI patients after successful fibrinolysis.
The hypothesis to be tested in this study is that the compression type of CAM is more likely to be present in patients who have subsequent STEMI than in age and sex matched control patients with normal coronary angiograms.
Twenty patients were identified who had coronary angiography after March 1998 and subsequently re-presented with a STEMI. STEMI was defined as ischemic chest pain with ST segment elevation of 1 mm in 2 contiguous limb leads or 2 mm in 2 contiguous chest leads. Patients were excluded if they had previous coronary artery bypass surgery or had stent thrombosis as the cause of STEMI. Twenty age and sex matched control patients were identified with normal coronary angiograms.
Clinical risk factors (hypertension, diabetes, smoking, family history and hypercholesterolemia) of all patients were obtained from the medical records.
Chi-squared tests were used for comparison of frequencies between groups. All statistical analyses were performed using Stata (version 10.0, StataCorp, College Station, TX).
The Royal Prince Alfred Hospital Ethics Review Committee approved the research protocol (reference X10-0159). The research protocol did not include obtaining patient consent.
Mean age (+/-stdev)
Current smoker (%)
Family history of coronary artery disease (%)
Frequency of each pattern and type of CAM
Pattern of CAM
This study shows that the proportion of the compression type of coronary artery motion for individual artery segments is not statistically significantly different between patients who have subsequent STEMIs and age and sex matched controls.
The main limitations of this study are its small sample size and the potential observer bias in the qualitative assessment of CAM. The technique relies on a visual assessment. Knowledge of the asymmetrical frequency distribution of culprit lesions in patients with STEMIs and the presence of stenosis within a segment may bias the qualitative visual assessor.
Previously published work has shown that the compression type of CAM is a predictor of the location of stenosis and the culprit segment responsible for STEMI[5, 11]. This study builds on this work by finding no difference in the proportion of the compression type of coronary artery motion between the STEMI population and normal controls. A possible explanation for these findings is that systemic factors determine whether a patient develops coronary atherosclerosis and local biomechanical and/or haemodynamic shear stress determines its location within the coronary arteries.
The authors would like to acknowledge Gai Riddell for retrieval of angiographic data.
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