Yonsei Med J.  2016 Jan;57(1):58-63. 10.3349/ymj.2016.57.1.58.

Prediction of Coronary Atherosclerotic Ostial Lesion with a Damping of the Pressure Tracing during Diagnostic Coronary Angiography

• Her AY
• Ann SH
• Singh GB
• Kim YH
• Koo BK
• Shin ES

• KMID: 2466352
• DOI: http://doi.org/10.3349/ymj.2016.57.1.58

Abstract

PURPOSE
When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG.
MATERIALS AND METHODS
In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups.
RESULTS
The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping.
CONCLUSION
Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.

Keyword

Pressure damping; ostial lesion; coronary angiography; intravascular ultrasound

MeSH Terms

Aged
*Coronary Angiography
Coronary Artery Disease/etiology/*radiography
Coronary Occlusion/diagnosis/*therapy
Coronary Stenosis/etiology/*radiography
Coronary Vessel Anomalies/radiography
Coronary Vessels/*pathology
Female
Humans
Incidence
Male
Middle Aged
Percutaneous Coronary Intervention/adverse effects/methods
Predictive Value of Tests
Proportional Hazards Models
Radiography, Interventional

Figure

• 

  Fig. 1 Coronary pressure showed an abrupt decline with a blunted pulse pressure during coronary pressure monitoring, in which both systolic and diastolic pressure were reduced as the catheter occluded the ostium.

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