Angiographic characterization and clinical implications of specific anatomical features in human coronary arteries

Abstract

The aim of this dissertation was to provide new insights into the role of invasive coronary angiography in risk stratification for patients with myocardial infarction in specific clinical scenarios.

Chapter 2 assessed the occurrence of occlusion of the atrial coronary artery in myocardial infarction patients undergoing emergency angioplasty and its impact on the occurrence of atrial arrhythmias. Chapter 3 focused on the impact of reduced coronary blood flow in the most developed atrial coronary branch and its potential role in the development of atrial arrhythmias in patients with myocardial infarction. Chapter 4 evaluated the effects of atrial ischemia in the left atrium due to reduced coronary blood flow in the dominant atrial coronary branch using advanced echocardiographic techniques. Our results showed that these patients had unfavorable anatomical and functional consequences.

Chapter 5 focused on patients presenting with acute coronary syndromes with coronary artery ectasia, which occurred in 4% of patients and was independently associated with an increased risk of severe cardiovascular events. Finally, in Chapter 6, we evaluated the angiographic and clinical profile of patients with COVID-19 who were referred for invasive coronary angiography during the first wave of the outbreak. We found that the most common indication was acute myocardial infarction, often due to high thrombus load. The incidence of severe events in the first month was high.

Overall, this dissertation provides important insights into the role of invasive coronary angiography in risk stratification for patients with myocardial infarction in specific clinical scenarios and highlights the potential consequences of reduced coronary blood flow in the development of atrial arrhythmias and unfavorable anatomical and functional consequences in patients with myocardial infarction.