| Objective:Analyze the relationship between left coronary artery bifurcation angle(LAD-LCX)and atherosclerosis in coronary artery angle proximal lumen by MSCT.Methods:Retrospective analysis clinical and imaging data of coronary artery CTA in six hospitals in Xinjiang region.(1)The angle of left coronary artery bifurcation,the length of left coronary artery main trunk and the area of adjacent lumen were measured.The correlation between the angle of left coronary artery bifurcation and the length of left coronary artery main trunk and the difference between male and female were analyzed and compared.(2)Coronary artery tree was observed and recorded for atherosclerotic plaque,plaque nature and stenosis degree of lumen according to 15 segments.The predisposing sites of coronary artery atherosclerosis were observed and analyzed.The adjacent lumen of left main coronary artery bifurcation was classified into grade ? to ? according to the degree of lumen stenosis and involvement or plaque type.The classification of different dimensions was analyzed and compared.The ROC curve was drawn to determine whether there was a CUT-OFF value of atherosclerotic plaque in the adjacent lumen of the left coronary artery angle.(3)Age,blood pressure,blood sugar,blood lipid,smoking history,family history,waist circumference/height and left coronary artery angle(?80°)were included in the equation.Logistic regression analysis was performed for the population,men and women.Results:In this study,we collected 2356 cases from 6 tertiary first-class hospitals in Xinjiang,of which 1.7%were coronary artery origin variants,81.15%were right dominant,7.39%were left dominant and 11.49%were average.Among 1877 cases of right dominant type,32.02%had middle vessel.In 1276 cases,the median angle between the left anterior descending branch and the left circumflex branch was 84±36°(65°,101°),of which 763males were 89±34°(71°,105°)and 513 females were 76±37°(59°,92°).The angle between left anterior descending branch and left circumflex branch in males was significantly larger than that in females(z=3.93,P<0.001).The median length of the left main coronary artery in 1276 patients was9.2±5.7mm(6.4mm,12.1mm),of which 763 males were 8.8±6.4mm(5.5mm,11.9mm)and 513 females were 8.8±6.4mm(5.5mm,11.9mm).The length of left main coronary artery in males was significantly longer than that in females(z=7.63,P<0.001).The length of left main coronary artery was significantly correlated with that of male and female(r=0.35,r=0.33,r=0.34,P<0.001).In 508 normal cases,the diameter of the main lumen of the left coronary artery was 4.24±1.23mm and the lumen area was14.1±8.6mm~2;the diameter of the lumen at the beginning of the left anterior descending branch was 3.48±0.77mm and the cross-sectional area of the lumen was 9.5±4.2mm~2;the diameter of the lumen at the beginning of the left circumflex branch was 3.21±1.07mm and the cross-sectional area of the lumen was 8.1±5.2mm~2.Compared with females,the lumen diameter and cross-sectional area of the left main coronary artery,the origin of left anterior descending branch and the origin of left circumflex branch in males were larger than those in females.(2)In the 15 segment of the coronary artery tree,proximal to the LAD for the most vulnerable segments,accounting for 23.15%;followed by RCA in 12.76%;LCX in11.53%;10.30%in the middle of LAD.The range of male coronary atherosclerosis was larger than that of female,and the proportion of male RCA proximal atherosclerotic plaque was higher than that of female.In the proximal segment of LAD,the proportion of male and female obstructive stenosis was similar,but in the middle segment of LAD,the proportion of female obstructive stenosis was larger than that of male,and in the proximal segment of RCA and LCX,the proportion of male obstructive stenosis was significantly higher than that of female.In general,the number of atherosclerotic plaques in the proximal lumen of the left coronary artery angle accounted for 96.25%of the total number of coronary atherosclerotic lesions,96.83%of males and 95.17%of females.For the adjacent segments(LM5,LAD6,LCX11)of the left coronary artery branch angle,according to the degree of lumen stenosis and plaque type,it was found that there were differences in the angle between the left coronary artery branch angle and atherosclerotic plaque,but there was no significant difference between the degree of stenosis and the nature of plaque.80°as the best cut-off point,can better reflect the influence of left coronary artery bifurcation angle on the proximal lumen atherosclerosis of left coronary artery bifurcation angle.(3)Logistic regression analysis showed that age,sex,angle of left coronary artery branch?80°,hypertension,diabetes mellitus,waist circumference/height>0.5,positive family history,smoking and hyperlipidemia could be independent risk factors for atherosclerotic plaque in the proximal segment of left coronary artery bifurcation angle.Overall,the probability of atherosclerotic plaque in the proximal segment of the left coronary artery branch angle(LAD-LCX)was 3.27 times higher than that in the<80°group,with 2.53 times for males and 5.33 times for females,when other factors remained unchanged.Conclusion:(1)The angle of left coronary artery bifurcation and the length of left coronary artery trunk in males are larger than that in females.The length of left coronary artery trunk is significantly correlated with the angle of left coronary artery bifurcation.The longer the length of left coronary artery trunk,the larger the angle of left coronary artery bifurcation.(2)There was a significant correlation between the angle of left coronary artery bifurcation and the cross-sectional area of the lumen at the beginning of the left circumflex branch.The larger angle of left coronary artery bifurcation,the larger the cross-sectional area of the lumen at the beginning of the left circumflex branch.(3)The proximal segment of the left coronary artery bifurcation angle is the key segment of coronary atherosclerosis,and the left coronary artery bifurcation angle of atherosclerosis is significantly larger than that of the left coronary artery bifurcation angle without atherosclerosis.(4)The angle of left coronary artery bifurcation(?80°)can be used as an independent risk factor for atherosclerotic plaque in proximal segment of left coronary artery bifurcation angle,and the effect on women is greater than that on men. |
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