Decreased size of the left anterior descending coronary artery is an independent predictor of deterioration in non-high-risk patients with acute pulmonary embolism


To evaluate the efficacy of measuring left coronary artery size to predict deterioration in non-high-risk acute pulmonary embolism (PE) patients. This retrospective study enrolled non-high-risk acute PE patients from January 2011 to December 2019. Patient deterioration was defined as the occurrence of adverse events within 30 days of hospital admission. Patients with adverse events were sex- and age-matched to patients without adverse events. Risk stratification was performed. Cross-sectional areas (CSAs) of the left main and left anterior descending (LAD) coronary artery inlets were measured. The main pulmonary artery (MPA) inlet and outlet and MPA LAD plane, which adjoined the LAD in the MPA, were reconstructed. CSAs, perimeters, and hydraulic diameters were measured to evaluate MPA size and deformation. Cardiac volume was also measured. Quantitative parameters were divided into tertiles. After adjustment by risk stratification, univariate and multivariate analyses were performed. Correlations between different parameters were analysed. Seventy-three patients with adverse events were matched to 73 patients without adverse events. The results of the univariate and multivariate analyses revealed that LAD inlet CSAs (middle and high) predicted adverse events (odds ratio: 0.28 and 0.07, 95% confidence interval: 0.10–0.77 and 0.02–0.22, p = 0.013 and < 0.0001). LAD inlet CSA was strongly and negatively correlated with MPA LAD hydraulic diameter and CSA (correlation coefficients: − 0.643 and − 0.604, p < 0.001). LAD inlet CSA measurement would facilitate adverse event prediction in non-high-risk acute PE patients on the basis of risk stratification. The dilated MPA may involve the decrease in LAD inlet CSA.

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This study received funding from the 345 Talent Project of Shengjing Hospital of China Medical University.

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DJ designed and performed the research as well as wrote the manuscript; YG designed and performed the research.

Corresponding author

Correspondence to Yizhuo Gao.

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All authors have no relevant conflicts of interest to disclose.

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This research was approved by the Institutional Review Board of Shengjing Hospital of China Medical University.

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Informed consent was not required for use of medical recording and image data as a retrospective study.

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Written informed consent for publication was obtained from all participants.

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Baseline and risk stratification of all patients with pulmonary embolism beforepropensity score matching Supplementary file1 (DOCX 12 kb)

Comparison of the parameters between adverse event (+) and adverse event (-)patients after propensity score matching Supplementary file2 (DOCX 14 kb)

Cardiac reconstruction and measurement volumesLA, left atria; RA, right atria; LV, left ventricle; RV, right ventricle Supplementary file3 (TIF 5678 kb)

Univariate analysis after adjustment by risk stratification. The LAD inlet CSA wascorrelated with adverse events in the three risk groups (ORs: 0.83, 0.67, and 0.83, 95% CI: 0.70–0.99,0.50–0.91, and 0.75–0.93, p=0.034, 0.0093, and 0.0013, p<0.05, respectively).MPA, main pulmonary artery; CSA, cross-sectional area; LMA, left main coronary artery; LAD, leftanterior descending coronary artery; LA, left atrium; RA, right atrium; LV, left ventricle; RV, rightventricle Supplementary file4 (TIF 7887 kb)

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Jia, D., Gao, Y. Decreased size of the left anterior descending coronary artery is an independent predictor of deterioration in non-high-risk patients with acute pulmonary embolism. J Thromb Thrombolysis 51, 168–175 (2021).

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  • Pulmonary embolism
  • Pulmonary artery
  • Coronary artery
  • Computed tomography