Diagnostic Value of Coronary CT Angiography With Use of Left Coronary Bifurcation Angle in Coronary Artery Disease

Background: Atherosclerosis generally occurs in the blood vessels with angulation or curvature, however, association between coronary bifurcation angle and coronary artery disease needs to be further clarified when compared to normal patients. Objectives: The aim of this study is to determine the relationship between left coronary bifurcation angle and development of coronary artery disease when compared to patients with normal coronary arteries. Methods: Fifty patients (40 men, mean age, 55.2 years) who underwent coronary computed tomography (CT) angiography for clinical diagnosis of coronary artery disease were included in the study. Of these patients, coronary plaques were present at one or more coronary arteries in 25 patients, while in the remaining 25 cases, no plaque was detected at the coronary arteries, thus serving as the control group. Left coronary bifurcation angle between left anterior descending and left circumflex was measured on 3D volume rendering images by two assessors with >80o as the cut-off value to determine significant stenosis. Results: The mean bifurcation angle was 72.9o±19.4o (range, 36o, 112o) among 50 patients. The mean bifurcation angle was significantly wider in patients with coronary plaques than that measured in patients with normal coronary artery (p<0.001), with corresponding values being 83.9o±17.5o (range, 45o,112o) and 62.5o±15.4o (range, 36o, 89o). Of 25 patients with coronary plaques, 18 (72%) had a bifurcation angle >80o, while only 12% of the patients had a bifurcation angle >80o in the control group. Conclusion: This study further confirms the direct relationship between left coronary bifurcation angle and development of coronary artery disease with diseased coronary arteries associated with wider angulation.