ReviewEuropean heart journal. Imaging methods and practice2026
A systematic review of left mainstem quadfurcation anatomy 'The Starfish Sign': an incidental finding or a variant of concern?
Review in European heart journal. Imaging methods and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
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Abstract
Left mainstem coronary artery quadrifurcation (LMQ) is a coronary variant with a wide-ranging estimated prevalence of 1.8-9.6%. Although often considered an incidental and benign finding, there is a dearth of literature to support this notion owing to suboptimal clinical characterization of this phenomenon. The aim of the current manuscript was to perform a systematic review of LMQ and to describe its prevalence, associated demographics and reported clinical outcomes. We furthermore propose new nomenclature for this finding. A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Eligible studies were detected for inclusion into the review using web-based sources (i.e. PubMed, Google Scholar) over a 20-year period from January 2005 to September 2025. Search terms included 'left mainstem quadrification/quadrifurcation/quadfurcation/tertrafurcation, coronary artery branches, coronary artery anomalies, and coronary intervention' using left main quadrifurcation and its wording variants. Where available, cardiovascular risk factors and clinical outcomes were recorded. Statistics were performed using SPSS V24 and R V3.4. LMQ prevalence was estimated by pooled analysis of cadaveric series using a DerSimonian-Laird random-effects model.
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