title: Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery.
abstract: BACKGROUND
  Restenosis after a percutaneous coronary intervention for proximal left anterior descending (pLAD) coronary artery disease remains a clinical challenge. However, the relationship between the left main trunk (LMT)/LAD bifurcation angle and the pLAD artery restenosis is unclear. This study examined the relationship between the LMT-LAD bifurcation angle and restenosis after stent implantation for pLAD disease.
  
  
  METHODS
  We analysed the data of 177 consecutive patients who underwent stent implantation for pLAD disease, followed by coronary angiography between December 2008 and September 2013. The LMT-LAD bifurcation angle was measured in the left or the right anterior oblique caudal (CAU) angiographic view.
  
  
  CONCLUSIONS
  Out of 177 patients, 12 developed in-stent restenosis and 21 developed in-segment restenosis. The mean angle in patients with in-stent restenosis (52.2°±14.5°) in the left anterior oblique CAU view was significantly larger than that in patients without restenosis (32.0°±18.1°; P<0.001). The LMT-LAD angle in the right anterior oblique CAU view was significantly larger in patients with in-segment restenosis (27.3°±14.3°) than in patients without restenosis (17.5°±10.1°; P<0.001). Moreover, by multivariate analysis, the LMT-LAD angle was an independent predictor of in-stent and in-segment restenosis, after adjustment for significant confounders such as diabetes, hypertension, dyslipidaemia, final minimum lesion diameter and lesion length.
  
  
  CONCLUSIONS
  This study suggests that a wide LMT-LAD angle is a predictor of restenosis after stent implantation for pLAD artery disease.
authors.affiliation: aDepartment of Cardiology, Hokkaido Cardiovascular Hospital bDepartment of Translational Pathology, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Konishi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Naohiro
authors.initials: N
authors.lastname: Funayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hotta
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome