Angiography-Derived Radial Wall Strain Across All Epicardial Vessels Before Acute Coronary Syndrome: The CULPRIT-STRAIN Study
Authors' conclusion
Among patients who developed ACS, RWSmax demonstrated marked culprit-vessel predominance despite frequent multivessel elevation, indicating a graded distribution across vessels. These retrospective findings do not establish prospective risk prediction and require validation in unselected populations with event-free controls.
Study context
- Population
- Consecutive acute coronary syndrome (ACS) patients with a prior coronary angiogram (≥3 months before event)
- Participants
- 101 patients303 vessels
- Exposure
- Within-patient comparison of culprit vs nonculprit RWSmax
- Outcome
- RWSmax, culprit vs nonculprit vessels (within-patient)
- Follow-up
- Index angiogram
Methodological detailsconsecutive ACS patients, prospectively maintained registry, retrospective
- Consecutive ACS patients
- Prospectively maintained registry
- Retrospective
Main finding
As reported in the abstract
P < 0.001
- Culprit vessel had the highest RWSmax
- 96 patients (95.0%; P < 0.001)
- Median within-patient ΔRWS
- 7.0% (IQR: 3.6%-13.2%)
Observational data: associations, not effects.
Secondary outcomes
Association of culprit-vessel RWSmax with index-to-ACS interval · median index-to-ACS interval, 35 months
- Higher culprit-vessel RWSmax associated with shorter index-to-ACS interval
- ρ = −0.34; P < 0.001
- Exploratory analysis
Patients with ≥2 vessels with RWSmax >12%
- Patients with ≥2 vessels with RWSmax >12%
- 60.4%
Original publication
Angiography-Derived Radial Wall Strain Across All Epicardial Vessels Before Acute Coronary Syndrome: The CULPRIT-STRAIN Study. JACC Adv. Published 6 October 2026. doi:10.
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