side-branch diameters from an atlas of 300 patients...kassab, d. bhatt, t. lefevre, y. louvard....
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Side-branchdiametersfromanatlasof300patients
Dr SusannBeier
Background
• AfterPCIincreasedriskifside-branch(SB)isoccluded(~5%ofpatients)
• PotentialischaemicmyocardiumaffecteddependsonSBcalibre
• Atlasofpopulationshapecanprovideinsightsmyocardiumatrisk
PercentageInfarcttoSB
GS.Kassab,D.Bhatt,T.Lefevre,Y.Louvard.EuroIntervention 2013;8:1461-3
Relation between diameter/area of SB and % infarctrelative to the mass perfused by the most proximal artery
PercentageInfarcttoSB
GS.Kassab,D.Bhatt,T.Lefevre,Y.Louvard.EuroIntervention 2013;8:1461-3
PercentageInfractCalculationfortheArteryandtheAtlas
M=massA=area
• Atlas:64-CT,55±9years,n=300,64%female,zerocalciumscoreandnostenosis
% Infarct Artery = (MSB/ MMA) * 100
= (ASB/ AMA) 4/3 * 100
GS.Kassab,D.Bhatt,T.Lefevre,Y.Louvard.EuroIntervention 2013;8:1461-3
Medrano,OrmistonBeieretal.EuroIntervention 2016;12:845-854
LMdiametersinalargepopulationWhole population(mm)
Mean SD Q1 Q2 Q3
MA 3.5 0.8 3.2 3.6 4.1
SB 3 0.7 2.5 3.1 3.5
%infarct_LM 52% 66%
LMdiametersinalargepopulationMales,N=66
Mean Q1 Q3
MA 4.1 3.6 4.6SB 3.6 3.1 3.9%infarct_LM 64% 71%
Females, N=151
Mean Q1 Q3
3.5 3.2 4.1
3 2.5 3.5
59% 69%
LADdiametersinalargepopulation
D(mm) Mean SD Q1 Q2 Q3 %Infarct
MA 3.3 0.8 2.9 3.3 3.8 32-34%
SB 2.2 0.6 1.9 2.2 2.5
Males,N=88
Mean Q1 Q3 26-33%
MA 3.7 3.3 4.1
SB 2.4 2.0 2.7
Females, N=149
Mean Q1 Q3 39-46%
3.0 2.4 3.4
2.1 1.8 2.4
LCx diametersinalargepopulationD(mm) Mean SD Q1 Q2 Q3 %Infarct
MA 3.2 0.7 2.8 3.2 3.7 43-46%
SB 2.4 0.6 2.1 2.3 2.7
Males,N=58
Mean Q1 Q3 31-48%
MA 3.8 3.4 4.2
SB 2.7 2.2 3.2
Females, N=149
Mean Q1 Q3 45-49%
3.0 2.5 3.5
2.3 1.9 2.6
RCAdiametersinalargepopulationD(mm) Mean SD Q1 Q2 Q3 %Infarct
MA 3.4 0.6 3.0 3.4 3.8 30-36%
SB 2.2 0.7 1.9 2.2 2.6
Males,N=64
Mean Q1 Q3 24-33%
MA 3.7 3.4 4.1
SB 2.4 2.0 2.7
Females, N=107
Mean Q1 Q3 28-34%
3.2 2.9 3.6
2.1 1.8 2.4
%InfarctoftheentiremyocardiumbasedontheAtlas
Mean Q1 Q2D_SB 3 2.5 3.5D_LMCA 3.5 3.2 4.1D_RCA 3.4 3 3.8%Infarct–Heart 34% 28% 36%
% Infarct Heart = [MSB/ (MLMCA+MRCA)] * 100
= [ASB4/3/ (ALMCA
4/3+ARCA4/3) ] * 100
Conclusion
• Ifthemyocardialregionatriskissignificant(~20%ofthemyocardial),thenrestorationoffullbloodflowthroughtheSBshouldbecomeaPCIfocus
• %infarctwasalwayssignificantinalargepopulation
• ThisindicatesthattheSBshouldalwaysberestored
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