CULPRIT LESION AND JEOPARDIZED MYOCARDIUM - CORRELATION BETWEEN CORONARY ANGIOGRAPHY AND SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY

Background: The term ''culprit lesion'' is used to designate the coron ary stenosis responsible for the symptoms of the pa tient with coronar y artery disease. Its detection is essential when partial revasculariz ation is contemplated. The term ''jeopardized myocardium'' is commonly used to mean the amount of myocardium put in danger by all the stenot ic lesions; however, it should be restricted to the amount of myocardi um that could become infarcted if only the most severe stenoses were o ccluded. Hypothesis: The aim of this study was to investigate (1) the agreement between coronary myocardial single-photon emission computed tomography (SPECT) and coronary angiography for the identification of the culprit lesion, and (2) the correlation of the two studies in the quantification of jeopardized myocardium.Methods: In all, 159 patients with coronary artery disease without previous myocardial infarction w ere included in the study. A score for myocardial SPECT was correlated with the angiographic scores by Califf and Gensini and with the autho rs' score which includes adjustment for collateral circulation. Result s: The agreement between coronary angiography and SPECT for the diagno sis of the culprit lesion was 84% (87/104). The correlations between t he scores of angiography and SPECT to assess jeopardized myocardium wh en all coronary stenoses were taken into account were significant (p < 0.0001), but their coefficients were suboptimal (r = 0.48 for Califf, r = 0.48 for Gensini, and r = 0.65 for the authors' score). When only the jeopardized myocardium resulting from the culprit lesion was cons idered, the correlation clearly improved (r = 0.85). Conclusion: Thus, in 84% of patients with multivessel disease, an agreement between cor onary angiography and myocardial SPECT for the diagnosis of the culpri t lesion was observed. The correlation between these techniques for th e quantification of jeopardized myocardium from the culprit lesion was satisfactory.