Challenging Diagnosis of Myocardial Infarction Due to Anomalous Left Circumflex
            Artery

Opolski, Maksymilian P.; Grodecki, Kajetan; Śpiewak, Mateusz; Furmanek, Mariusz; Michałowska, Ilona

doi:10.5935/abc.20180093

Cited by 2 publications

(6 citation statements)

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“…These findings are consistent with previous reports, illustrating that diagnostic catheterization and PCI of an aberrant LCx is technically challenging 10,18,19 . Delays in suspecting the presence or identifying an aberrant LCx, especially in the setting of an ACS, may lead to the false diagnosis of MINOCA, cause incomplete or delayed revascularization resulting in larger infarct size and impaired prognosis 10,18 . With the advent of transcatheter aortic valve implantation in recent years, there is a risk for compression of the aberrant LCx by the prosthetic valve, if the anomalous artery is not recognized preprocedurally 18 .…”

Section: Discussionsupporting

confidence: 86%

“…Finally, separate ostia of the LAD and LCx from the left coronary sinus, which could potentially give a long LM-length (actually the LAD), is quite easy to identify through overspilling of contrast in the adjacent ostium.Cardiac catheterization in the aberrant LCx group required 1.31 times more contrast volume and 1.66 times longer total fluoroscopy time compared to the group with normal anatomy. These findings are consistent with previous reports, illustrating that diagnostic catheterization and PCI of an aberrant LCx is technically challenging 10,18,19.…”

supporting

confidence: 93%

“…First, a long LM should prompt the operator to be alert to the Delays in suspecting the presence or identifying an aberrant LCx, especially in the setting of an ACS, may lead to the false diagnosis of MINOCA, cause incomplete or delayed revascularization resulting in larger infarct size and impaired prognosis. 10,18 With the advent of transcatheter aortic valve implantation in recent years, there is a risk for compression of the aberrant LCx by the prosthetic valve, if the anomalous artery is not recognized preprocedurally. 18 Therefore, timely suspicion and angiographic identification of an aberrant LCx is of utmost importance (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of an acute coronary syndrome (ACS), failure to recognize an aberrant LCx may delay percutaneous coronary intervention (PCI) or result in a misdiagnosis of myocardial infarction with normal coronary arteries (MINOCA). 10 Thus, timely suspicion and angiographic identification of an aberrant LCx is crucial.…”

Section: Introductionmentioning

confidence: 99%

“…This could be due to misinterpretation of the ramus intermedius or obtuse marginal branch as the LCx, presumption that the LCx is occluded, or other technical challenges, which lead to larger contrast volumes and high radiation exposure. In the setting of an acute coronary syndrome (ACS), failure to recognize an aberrant LCx may delay percutaneous coronary intervention (PCI) or result in a misdiagnosis of myocardial infarction with normal coronary arteries (MINOCA) 10 . Thus, timely suspicion and angiographic identification of an aberrant LCx is crucial.…”

Section: Introductionmentioning

confidence: 99%

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Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Triantafyllis

Nunen

Lesizza

et al. 2022

Cathet Cardio Intervent

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Objectives To identify angiographic predictors of aberrant left circumflex artery (LCx) by comparing left main (LM) length and bifurcation angle between patients with aberrant LCx and normal anatomy. Background Failure to recognize aberrant LCx during a cardiac catheterization may hamper correct diagnosis, delay intervention in acute coronary syndromes, and result in increased contrast volume, radiation exposure, and infarct size. Methods We retrospectively analyzed angiograms of aberrant LCx patients and normal anatomy matched controls, in three‐participating centers. LM‐length, bifurcation angle between the left anterior descending (LAD) and the first non‐LAD branch of the LM, and procedural data were compared. Results Between 2003 and 2020, 136 patients with aberrant LCx and 135 controls were identified. More catheters (2.4 ± 0.6 vs. 2.2 ± 0.9, p = 0.009), larger contrast volumes (169 ± 94 ml vs. 129 ± 68 ml, p < 0.0005), and prolonged fluoroscopy time (652.9 ± 623.7 s vs. 393.1 ± 332.1 s, p < 0.0005), were required in the aberrant LCx‐group compared with controls. Patients with aberrant LCx had a longer LM‐length and a more acute bifurcation angle, both in caudal and cranial views, compared with controls (24.7 ± 8.1 vs. 10.8 ± 4.5 mm, p < 0.0005 and 26.7 ± 7.4 vs. 12 ± 5.5 mm, p < 0.0005, respectively, and 45.2° ± 12° vs. 88.8° ± 23°, p < 0.0005 and 51.9° ± 21° vs. 68.2° ± 28.3°, p < 0.0005, respectively). In ROC analysis, LM‐length showed the best diagnostic accuracy for detecting aberrant LCx. In multiple logistic regression analysis, a cranially measured LM‐length > 17.7 mm was associated with a 5.3 times greater probability of predicting aberrant LCx [95% CI (3.4–8.1), p < 0.0001]. Conclusions Our study suggests that a long LM‐length and an acute bifurcation angle can indicate the presence of aberrant LCx. We present a practical algorithm for its rapid identification.

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Section: Discussionsupporting

confidence: 86%

supporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Triantafyllis

Nunen

Lesizza

et al. 2022

Cathet Cardio Intervent

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Pacientes com Infarto Agudo do Miocárdio com supradesnivel do segmento ST e angioplastia primária comparada a trombólise: redução considerável da morbimortalidade

Mundim Melo,

Ribeiro de Castro Nunes,

Resende Pompeu

et al. 2023

Rev. Mas

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O objetivo central desta Revisão Sistemática é relatar se há redução considerável da morbimortalidade em pacientes com Infarto Agudo do Miocárdio com supradesnível do segmento ST (IAMCSST) submetidos à angioplastia primária (ICP) comparado a trombólise. Para esta revisão bibliográfica foram selecionados alguns estudos publicados nas bases de dados eletrônicas como: PubMed, Medline, Lilacs, SciELO e Bireme. Com base nos 12 artigos utilizados, foi realizada a comparação das duas estratégias de tratamento com foco na mortalidade em 30 dias (desfecho primário). A amostra final foi composta por 2.470 pacientes. Seguindo o protocolo de atendimento, fibrinólise foi fornecida a 243 pacientes (9,8% - grupo fibrinólise) e 2.227 pacientes foram transferidos para um centro de PCI (90,2% - grupo de transferência para a ICP). O tempo médio para ICP foi de 119 minutos. A mortalidade apresentou tendência a ser menor no grupo ICP x Fibrinólise (5,1% x 7,7%, P = 0,09). No entanto, quando avaliados pacientes transferidos em até 99 minutos até ICP, a mortalidade foi de 2,0% (P<0,01) e entre 99 e 140 minutos foi de 4,6% (P = 0,03), significativamente menor no grupo ICP. Em pacientes submetidos a trombólise houve redução na mortalidade em 7,7% (p < 0,03), bem como verificou-se uma redução de 52 minutos no tempo de tratamento quando comparado com ICP e, consequentemente redução significativa da mortalidade a longo prazo. Portanto, o que vai influenciar na escolha do procedimento é o tempo.

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Challenging Diagnosis of Myocardial Infarction Due to Anomalous Left Circumflex Artery

Cited by 2 publications

References 0 publications

Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Angiographic predictors of aberrant circumflex artery during cardiac catheterization

Pacientes com Infarto Agudo do Miocárdio com supradesnivel do segmento ST e angioplastia primária comparada a trombólise: redução considerável da morbimortalidade

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