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Войти в исследования Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
Could Right Coronary Artery-Aorta Angle be Used to Predict Atherosclerotic Lesion Localization in Critical Site of the Right Coronary Artery in Patients With Right Dominancy?
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Faideci Emre Melik, Alak Mehmet Emin, Güzel Sinan, Bekler Özkan, Güven Gülden, Hancıoğlu Emirhan, Çolakoğlu Gevher Ceyla Zeynep, Özcan Sevgi, Dönmez Esra, Ziyrek Murat
Аннотация
BACKGROUND: This study aimed to evaluate the impact of the aorta-right coronary artery angle (ARA) on lesion localization and its protective effect in the critical osteal region in patients with dominant right coronary artery (RCA).
METHODS: This cross-sectional study included 294 patients who underwent elective coronary angiography for stable angina pectoris and had a single significant lumen stenosis (50%-95%) before the RCA crux. Patients with tortuous vessels, previous interventions, left-dominant circulation, or insufficient image quality were excluded. ARA, lesion criticality, length, and distance from the aorto-osteal junction were calculated using quantitative coronary analysis. Patients were categorized based on lesion location: osteal, proximal, mid, and distal regions.
RESULTS: ARA increased significantly as the lesion localization moved distally (osteal: 53.26° ± 5.65°, proximal: 60.79° ± 9.53°, mid: 82.33° ± 9.85°, distal: 93.53° ± 7.46°; p < 0.0001). A strong positive correlation was found between ARA and the distance of the lesion from the aorto-osteal junction (r = 0.759, p < 0.0001). In binary regression, ARA was the only independent risk factor for critical lesion localization in the osteal region (OR = 0.915; 95% CI 0.868-0.965, p < 0.001). ROC analysis showed that an ARA > 73.50° had 83.2% sensitivity and 81.3% specificity for excluding critical lesions in the osteal region (AUC = 0.861; 95% CI 0.815-0.907).
CONCLUSION: A narrow ARA increases the likelihood of critical lesions in the osteal RCA, while an ARA > 73.50° is protective. These findings suggest ARA could guide risk assessment and treatment planning in coronary interventions.
METHODS: This cross-sectional study included 294 patients who underwent elective coronary angiography for stable angina pectoris and had a single significant lumen stenosis (50%-95%) before the RCA crux. Patients with tortuous vessels, previous interventions, left-dominant circulation, or insufficient image quality were excluded. ARA, lesion criticality, length, and distance from the aorto-osteal junction were calculated using quantitative coronary analysis. Patients were categorized based on lesion location: osteal, proximal, mid, and distal regions.
RESULTS: ARA increased significantly as the lesion localization moved distally (osteal: 53.26° ± 5.65°, proximal: 60.79° ± 9.53°, mid: 82.33° ± 9.85°, distal: 93.53° ± 7.46°; p < 0.0001). A strong positive correlation was found between ARA and the distance of the lesion from the aorto-osteal junction (r = 0.759, p < 0.0001). In binary regression, ARA was the only independent risk factor for critical lesion localization in the osteal region (OR = 0.915; 95% CI 0.868-0.965, p < 0.001). ROC analysis showed that an ARA > 73.50° had 83.2% sensitivity and 81.3% specificity for excluding critical lesions in the osteal region (AUC = 0.861; 95% CI 0.815-0.907).
CONCLUSION: A narrow ARA increases the likelihood of critical lesions in the osteal RCA, while an ARA > 73.50° is protective. These findings suggest ARA could guide risk assessment and treatment planning in coronary interventions.