High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction
Arnav Kumar, Elizabeth W. Thompson, Adrien Lefieux, David S. Molony, Emily L. Davis, Nikita Chand, Stephane Fournier, Hee Su Lee, Jon Suh, Kimi Sato, Yi-An Ko, Daniel Molloy, Karthic Chandran, Hossein Hosseini, Sonu Gupta, Anastasios Milkas, Bill Gogas, Hyuk-Jae Chang, James K. Min, William F. Fearon, Alessandro Veneziani, Don P. Giddens, Spencer B. King III, Bernard De Bruyne and Habib Samady
High Wall Shear Stress Predicts Myocardial Infarction
(A) Atherosclerotic lesion segmentation for wall shear stress calculation. Angiograms were used to create 3-dimensional geometric reconstructions of each patient’s target coronary vessel lumen. After performing computational fluid dynamics with patient-specific boundary conditions and identifying the lesion start points and endpoints, segment-specific wall shear stress values were generated by dividing the lesion into 5 segments: proximal, middle and distal thirds of the lesion; and 5-mm segments upstream and downstream to the lesion. The lesion wall shear stress values are displayed as a color-coded map. (B) Kaplan-Meier curves of vessel-related study population (n = 58) separated on the basis of wall shear stress measured in proximal segments of lesions to predict vessel-related myocardial infarction. Lesions with wall shear stress measured in proximal segments of lesions >4.71 Pa had higher rates of vessel-related myocardial infarction than lesions with wall shear stress measured in proximal segments of lesions ≤4.71 Pa (p = 0.012). Pa = Pascal; WSSprox = WSS measured in the proximal segments of lesions; WSS = wall shear stress.