The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions - Mini focus on bifurcation lesions

Anatomical attributes of clinically relevant diagonal branches in patients with left anterior descending coronary artery bifurcation lesions

EuroIntervention 2020;16:e715-e723. DOI: 10.4244/EIJ-D-19-00534

1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; 2. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 3. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; 4. Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea; 5. Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea; 6. Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea; 7. Department of Cardiology, Ajou University Hospital, Suwon, Republic of Korea

Aims: This study aimed to investigate the anatomical attributes determining myocardial territory of diagonal branches and to develop prediction models for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA).

Methods and results: The amount of ischaemia and subtended myocardial mass of diagonal branches was quantified using MPI by percent ischaemic myocardium (%ischaemia) and CCTA by percent fractional myocardial mass (%FMM), respectively. In 49 patients with isolated diagonal branch disease, the mean %ischaemia by MPI was 6.8±4.0%, whereas in patients with total occlusion or severe disease of all diagonal branches it was 8.4±3.3%. %ischaemia was different according to the presence of non-diseased diagonal branches and dominant left circumflex artery (LCx). In the CCTA cohort (306 patients, 564 diagonal branches), mean %FMM was 5.9±4.4% and 86 branches (15.2%) had %FMM ≥10%. %FMM was different according to LCx dominance, number of branches, vessel size, and relative dominance between two diagonal branches. The diagnostic accuracy of prediction models for %FMM ≥10% based on logistic regression and decision tree was 0.92 (95% CI: 0.85-0.96) and 0.91 (95% CI: 0.84-0.96), respectively. There was no difference in the diagnostic performance of models with and without size criterion.

Conclusions: LCx dominance, number of branches, vessel size, and dominance among diagonal branches determined the myocardial territory of diagonal branches. Clinical application of prediction models based on these anatomical attributes can help to determine the clinically relevant diagonal branches in the cardiac catheterisation laboratory. Clinical trial registration: NCT03935542

Visual summary. Myocardial territory of a diagonal branch is determined by LCx dominance, number of branches and dominance among branches.

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