{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:02:46Z","timestamp":1787166166144,"version":"build-2736575974"},"reference-count":16,"publisher":"Texas Heart Institute Journal","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:p>The prevalence of the left circumflex coronary artery (LCx) as the culprit vessel in ST-segment-elevation myocardial infarction (STEMI) is reportedly lowest among that of the 3 main epicardial arteries, and has not been described for non-STEMI (NSTEMI) and stable angina pectoris. We sought to define the distribution of culprit arteries in these clinical presentations and suggest mechanisms for the differences.<\/jats:p>\n                  <jats:p>We reviewed 189 coronary angiograms of patients with STEMI, 203 with NSTEMI, and 548 with stable angina (n=940), and compared distributions of stenotic and culprit coronary arteries (lesions prompting intervention).<\/jats:p>\n                  <jats:p>\n                    Obstructive coronary lesions (\u226550% narrowing) were more prevalent in the left anterior descending coronary artery (LAD) (36%\u201338%) and similar in the LCx and right coronary artery (RCA) (27%\u201329%), regardless of clinical presentation (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01). In NSTEMI and stable angina, culprit vessels and total obstructive disease had the same distribution. In STEMI, however, a culprit LCx was significantly less prevalent (17%) than was total obstructive disease (27%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01), or a culprit LAD (47%) or RCA (34%) (both\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001). In our computed tomographic angiographic model of coronary longitudinal strain (percentage of shortening), LCx strain was only 1.5% \u00b1 2.4%, versus 9.5% \u00b1 2.9% for LAD strain and 10.1% \u00b1 3.9% for RCA strain.\n                  <\/jats:p>\n                  <jats:p>In STEMI, LCx plaques seem less prone to rupturing. Culprit and total disease distributions are similar in NSTEMI and angina, suggesting a different ischemic pathophysiology in these presentations. Lower LCx longitudinal strain might contribute to reduced plaque rupture in STEMI.<\/jats:p>","DOI":"10.14503\/thij-16-5905","type":"journal-article","created":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T17:07:00Z","timestamp":1509469620000},"page":"320-325","source":"Crossref","is-referenced-by-count":12,"title":["Left Circumflex Coronary Artery as the Culprit Vessel in ST-Segment-Elevation Myocardial Infarction"],"prefix":"10.14503","volume":"44","author":[{"given":"Diab","family":"Ghanim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Kusniec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wadi","family":"Kinany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahud","family":"Qarawani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Meerkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Taha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Offer","family":"Amir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shemy","family":"Carasso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5628","reference":[{"issue":"6","key":"i1526-6702-44-5-320-b1","series-title":"Ann Intern Med","first-page":"387","article-title":"The vulnerable atherosclerotic plaque: scope of the literature","volume":"153","year":"2010","unstructured":"Alsheikh-Ali\n              AA\n            , KitsiosGD, BalkEM, LauJ, IpS.\n          The vulnerable atherosclerotic plaque: scope of the literature. Ann Intern Med2010;153(6):387\u201395."},{"issue":"8","key":"i1526-6702-44-5-320-b2","series-title":"Coron Artery Dis","first-page":"533","article-title":"Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention","volume":"22","year":"2011","unstructured":"Antoni\n              ML\n            , YiuKH, AtaryJZ, DelgadoV, HolmanER, van der WallEE, \n          et al. Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention. Coron Artery Dis2011;22(8):533\u20136."},{"issue":"22","key":"i1526-6702-44-5-320-b3","series-title":"Eur Heart J","first-page":"2814","article-title":"Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy","volume":"32","year":"2011","unstructured":"Ozaki\n              Y\n            , OkumuraM, IsmailTF, MotoyamaS, NaruseH, HattoriK, \n          et al. Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy. Eur Heart J2011;32(22):2814\u201323."},{"issue":"8","key":"i1526-6702-44-5-320-b4","series-title":"Am J Cardiol","first-page":"1081","article-title":"Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation","volume":"106","year":"2010","unstructured":"From\n              AM\n            , BestPJ, LennonRJ, RihalCS, PrasadA.\n          Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation. Am J Cardiol2010;106(8):1081\u20135."},{"issue":"2","key":"i1526-6702-44-5-320-b5","series-title":"J Interv Cardiol","first-page":"140","article-title":"Anatomic characteristics of culprit sites in acute coronary syndromes","volume":"21","year":"2008","unstructured":"Katritsis\n              DG\n            , EfstathopoulosEP, PantosJ, KorovesisS, KourlabaG, KazantzidisS, \n          et al. Anatomic characteristics of culprit sites in acute coronary syndromes. J Interv Cardiol2008;21(2):140\u201350."},{"issue":"2","key":"i1526-6702-44-5-320-b6","series-title":"Am J Emerg Med","first-page":"183","article-title":"Significance of left circumflex artery-related acute myocardial infarction without ST-T changes","volume":"28","year":"2010","unstructured":"Chua\n              SK\n            , ShyuKG, ChengJJ, LiouJY, LinSC, HungHF, \n          et al. Significance of left circumflex artery-related acute myocardial infarction without ST-T changes. Am J Emerg Med2010;28(2):183\u20138."},{"issue":"6","key":"i1526-6702-44-5-320-b7","series-title":"Catheter Cardiovasc Interv","first-page":"1001","article-title":"2015 ACC\/AHA\/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"87","year":"2016","unstructured":"PCI Writing Committee, LevineGN, BatesER, BlankenshipJC, BaileySR, BittlJA, \n          et al. 2015 ACC\/AHA\/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv2016;87(6):1001\u201319."},{"issue":"10","key":"i1526-6702-44-5-320-b8","series-title":"N Engl J Med","first-page":"933","article-title":"Use of the electrocardiogram in acute myocardial infarction","volume":"348","year":"2003","unstructured":"Zimetbaum\n              PJ\n            , JosephsonME.\n          Use of the electrocardiogram in acute myocardial infarction. N Engl J Med2003;348(10):933\u201340."},{"issue":"1","key":"i1526-6702-44-5-320-b9","series-title":"J Am Soc Echocardiogr","first-page":"1","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","year":"2015","unstructured":"Lang\n              RM\n            , BadanoLP, Mor-AviV, AfilaloJ, ArmstrongA, ErnandeL, \n          et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr2015;28(1):1\u201339.e14."},{"issue":"2","key":"i1526-6702-44-5-320-b10","series-title":"Circulation","first-page":"240","article-title":"The prognostic significance of 50% coronary stenosis in medically treated patients with coronary artery disease","volume":"62","year":"1980","unstructured":"Harris\n              PJ\n            , BeharVS, ConleyMJ, HarrellFEJr, LeeKL, PeterRH, \n          et al. The prognostic significance of 50% coronary stenosis in medically treated patients with coronary artery disease. Circulation1980;62(2):240\u20138."},{"issue":"2","key":"i1526-6702-44-5-320-b11","series-title":"Atherosclerosis","first-page":"271","article-title":"Combination of plaque burden, wall shear stress, and plaque phenotype has incremental value for prediction of coronary atherosclerotic plaque progression and vulnerability","volume":"232","year":"2014","unstructured":"Corban\n              MT\n            , EshtehardiP, SuoJ, McDanielMC, TimminsLH, Rassoul-ArzrumlyE, \n          et al. Combination of plaque burden, wall shear stress, and plaque phenotype has incremental value for prediction of coronary atherosclerotic plaque progression and vulnerability. Atherosclerosis2014;232(2):271\u20136."},{"issue":"6","key":"i1526-6702-44-5-320-b12","series-title":"J Biomech Eng","first-page":"734","article-title":"Strain measurement in coronary arteries using intravascular ultrasound and deformable images","volume":"124","year":"2002","unstructured":"Veress\n              AI\n            , WeissJA, GullbergGT, VinceDG, RabbittRD.\n          Strain measurement in coronary arteries using intravascular ultrasound and deformable images. J Biomech Eng2002;124(6):734\u201341."},{"issue":"7","key":"i1526-6702-44-5-320-b13","series-title":"J Biomech Eng","first-page":"1195","article-title":"Measurement of strain in the left ventricle during diastole with cine-MRI and deformable image registration [published erratum appears in J Biomech Eng 2006;128(5):802]","volume":"127","year":"2005","unstructured":"Veress\n              AI\n            , GullbergGT, WeissJA.\n          Measurement of strain in the left ventricle during diastole with cine-MRI and deformable image registration [published erratum appears in J Biomech Eng 2006;128(5):802]. J Biomech Eng2005;127(7):1195\u2013207."},{"issue":"5","key":"i1526-6702-44-5-320-b14","series-title":"Chest","first-page":"1540","article-title":"Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads","volume":"120","year":"2001","unstructured":"Schmitt\n              C\n            , LehmannG, SchmiederS, KarchM, NeumannFJ, SchomigA.\n          Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads. Chest2001;120(5):1540\u20136."},{"issue":"5","key":"i1526-6702-44-5-320-b15","series-title":"J Am Soc Echocardiogr","first-page":"543","article-title":"Velocity vector imaging: standard tissue-tracking results acquired in normals--the VVI-STRAIN study","volume":"25","year":"2012","unstructured":"Carasso\n              S\n            , BiaggiP, RakowskiH, MutlakD, LessickJ, AronsonD, \n          et al. Velocity vector imaging: standard tissue-tracking results acquired in normals--the VVI-STRAIN study. J Am Soc Echocardiogr2012;25(5):543\u201352."},{"issue":"4","key":"i1526-6702-44-5-320-b16","series-title":"J Invasive Cardiol","first-page":"161","article-title":"Longitudinal deformation of drug-eluting stents: evaluation by multislice computed tomography","volume":"26","year":"2014","unstructured":"Romaguera\n              R\n            , RouraG, Gomez-LaraJ, FerreiroJL, GracidaM, TeruelL, \n          et al. Longitudinal deformation of drug-eluting stents: evaluation by multislice computed tomography. 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