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.
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.