Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions

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

Research output: Contribution to journalArticle

7 Citations (Scopus)

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. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409)

Original languageEnglish
Pages (from-to)1126-1132
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume5
Issue number11
DOIs
Publication statusPublished - 2012 Nov 1
Externally publishedYes

Fingerprint

Coronary Vessels
Arterial Pressure
Electrocardiography
Pulmonary Wedge Pressure
Coronary Occlusion
Chest Pain
Pathologic Constriction
Pressure
Pain
Therapeutics
Lead

Keywords

  • bifurcation
  • coronary disease
  • electrocardiography
  • physiology
  • stenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions. / 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.

In: JACC: Cardiovascular Interventions, Vol. 5, No. 11, 01.11.2012, p. 1126-1132.

Research output: Contribution to journalArticle

Koo, BK, Lee, SP, Lee, JH, Park, KW, Suh, JW, Cho, YS, Chung, WY, Doh, JH, Nam, CW, Yu, CW, Lee, BK, Vassilev, D, Gil, R, Lim, HS, Tahk, SJ & Kim, HS 2012, 'Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions', JACC: Cardiovascular Interventions, vol. 5, no. 11, pp. 1126-1132. https://doi.org/10.1016/j.jcin.2012.05.018
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. / Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions. In: JACC: Cardiovascular Interventions. 2012 ; Vol. 5, No. 11. pp. 1126-1132.
@article{aae94cdb2ad74890979cce1dae5933a1,
title = "Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions",
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. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409)",
keywords = "bifurcation, coronary disease, electrocardiography, physiology, stenosis",
author = "Koo, {Bon Kwon} and Lee, {Seung Pyo} and Lee, {Ju Hee} and Park, {Kyung Woo} and Suh, {Jung Won} and Cho, {Young Seok} and Chung, {Woo Young} and Doh, {Joon Hyung} and Nam, {Chang Wook} and Yu, {Cheol Woong} and Lee, {Bong Ki} and Dobrin Vassilev and Robert Gil and Lim, {Hong Seok} and Tahk, {Seung Jea} and Kim, {Hyo Soo}",
year = "2012",
month = "11",
day = "1",
doi = "10.1016/j.jcin.2012.05.018",
language = "English",
volume = "5",
pages = "1126--1132",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "11",

}

TY - JOUR

T1 - Assessment of clinical, electrocardiographic, and physiological relevance of diagonal branch in left anterior descending coronary artery bifurcation lesions

AU - Koo, Bon Kwon

AU - Lee, Seung Pyo

AU - Lee, Ju Hee

AU - Park, Kyung Woo

AU - Suh, Jung Won

AU - Cho, Young Seok

AU - Chung, Woo Young

AU - Doh, Joon Hyung

AU - Nam, Chang Wook

AU - Yu, Cheol Woong

AU - Lee, Bong Ki

AU - Vassilev, Dobrin

AU - Gil, Robert

AU - Lim, Hong Seok

AU - Tahk, Seung Jea

AU - Kim, Hyo Soo

PY - 2012/11/1

Y1 - 2012/11/1

N2 - 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. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409)

AB - 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. (Comparison Between Main Branch and Side Branch Vessels; NCT01046409)

KW - bifurcation

KW - coronary disease

KW - electrocardiography

KW - physiology

KW - stenosis

UR - http://www.scopus.com/inward/record.url?scp=84869402761&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869402761&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2012.05.018

DO - 10.1016/j.jcin.2012.05.018

M3 - Article

C2 - 23174636

AN - SCOPUS:84869402761

VL - 5

SP - 1126

EP - 1132

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 11

ER -