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Abstract：
BACKGROUND: Asians have a much lower incidence of adverse coronary events than Caucasians. We sought to evaluate the characteristics of coronary lipid-rich plaques (LRP) in Asian patients with acute coronary syndrome (ACS) and stable angina (SA). We also aimed to identify surrogate markers for the extent of LRP.
METHODS: We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed.
RESULTS: The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385-745] vs. 361 [174-527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95-8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001).
CONCLUSIONS: We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.
METHODS: We evaluated 207 patients (ACS, n = 75; SA, n = 132) who underwent percutaneous coronary intervention under near infrared spectroscopy intravascular ultrasound (NIRS-IVUS). Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum lipid-core burden index (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed.
RESULTS: The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385-745] vs. 361 [174-527], p < 0.001) than the SA culprit lesions. On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥ 400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95-8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and systematic biomarkers (hs-CRP, IL-6, TNF-α), whereas the extent of LRP was positively correlated with IVUS plaque burden (r = 0.24, p < 0.001).
CONCLUSIONS: We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from SA culprit lesions, and that a threshold maxLCBI4mm ≥ 400 was clinically suitable in Japanese patients. No surrogate maker for a high-risk LRP was found; consequently, direct intravascular evaluation of plaque characteristics remains important.
摘要：
背景：亚洲人的不良冠状动脉事件发生率远低于白种人。我们试图评估亚洲急性冠状动脉综合征（ACS）和稳定型心绞痛（SA）患者的冠状动脉富含脂质斑块（LRP）的特征。我们还旨在鉴定LRP程度的替代标记。
方法：我们评估了207例患者（ACS，n=75；SA，n=132）在近红外光谱血管内超声（NIRS-IVUS）下接受经皮冠状动脉介入治疗的患者。分析了从头罪犯和非罪犯段中NIRS的斑块特征和LRP的范围[定义为具有4毫米最大脂质核心负荷指数（maxLCBI4mm）的长段]。
结果：ACS罪犯病变的maxLCBI4mm明显更高（中位数[四分位距（IQR）]：533[385-745]vs.361[174-527],p<0.001）比SA的罪魁祸首病变。在多变量逻辑分析中，大的LRP(定义为maxLCBI4mm≥400)是ACS罪犯段的最强独立预测因子(比值比，3.87；95%置信区间，1.95-8.02)。在非罪犯部分，19.8％的患者至少有一个没有小管腔的大LRP。LRP的程度与系统生物标志物(hs-CRP，IL-6，TNF-α），而LRP程度与IVUS斑块负荷呈正相关(r=0.24,p<0.001)。
结论：我们证实NIRS-IVUS斑块评估可用于区分ACS和SA罪犯病变，并且阈值maxLCBI4mm≥400在日本患者中在临床上是合适的。没有发现高风险LRP的代理制造商；因此，直接血管内评价斑块特征仍然很重要.
方法：我们评估了207例患者（ACS，n=75；SA，n=132）在近红外光谱血管内超声（NIRS-IVUS）下接受经皮冠状动脉介入治疗的患者。分析了从头罪犯和非罪犯段中NIRS的斑块特征和LRP的范围[定义为具有4毫米最大脂质核心负荷指数（maxLCBI4mm）的长段]。
结果：ACS罪犯病变的maxLCBI4mm明显更高（中位数[四分位距（IQR）]：533[385-745]vs.361[174-527],p<0.001）比SA的罪魁祸首病变。在多变量逻辑分析中，大的LRP(定义为maxLCBI4mm≥400)是ACS罪犯段的最强独立预测因子(比值比，3.87；95%置信区间，1.95-8.02)。在非罪犯部分，19.8％的患者至少有一个没有小管腔的大LRP。LRP的程度与系统生物标志物(hs-CRP，IL-6，TNF-α），而LRP程度与IVUS斑块负荷呈正相关(r=0.24,p<0.001)。
结论：我们证实NIRS-IVUS斑块评估可用于区分ACS和SA罪犯病变，并且阈值maxLCBI4mm≥400在日本患者中在临床上是合适的。没有发现高风险LRP的代理制造商；因此，直接血管内评价斑块特征仍然很重要.
