Abstract：
Previous studies reported a robust relation between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). Systemic inflammation has been proposed as possible pathogenetic mechanism linking these 2 entities, although data on atherosclerotic coronary features in COPD patients are lacking. We studied atherosclerotic coronary plaque features in COPD patients presenting with acute coronary syndrome (ACS) using optical coherence tomography (OCT). ACS patients who underwent intracoronary OCT imaging of the culprit vessel were enrolled. Coronary plaque characteristics and OCT-defined macrophage infiltration (MØI) were assessed by OCT. ACS patients were divided into 2 groups according to the presence of an established diagnosis of COPD, and plaque features at the culprit site and along the culprit vessel were compared between the groups. Of 146 ACS patients (mean age:66.1 ± 12.7 years, 109 men), 47 (32.2%) had COPD. Patients with COPD had significantly higher prevalence of MØI (78.7% vs 54.5%, p = 0.005) and thin cap fibroatheroma (TCFA) (48.9% vs 22.2%, p = 0.001) at the culprit site. In the multivariate logistic regression, COPD was independently associated with MØI (odds ratio [OR] 21.209, 95% confidence interval [CI] 1.679 to 267.910, p = 0.018) and TCFA at the culprit site (OR 5.345, 95% CI 1.386 to 20.616, p = 0.015). Similarly, COPD was independently associated with both MØI (OR 3.570, 95% CI 1.472 to 8.658, p = 0.005) and TCFA (OR 4.088, 95% CI 1.584 to 10.554, p = 0.004) along the culprit vessel. In conclusion, in ACS patients who underwent OCT imaging of the culprit vessel, COPD was an independent predictor of plaque inflammation and vulnerability. These results may suggest that a higher inflammatory milieu in COPD patients might enhance local coronary inflammation, promoting CAD development and plaque vulnerability.
摘要：
先前的研究报道了慢性阻塞性肺疾病（COPD）和冠状动脉疾病（CAD）之间的密切关系。系统性炎症已被认为是连接这两个实体的可能的致病机制，尽管缺乏COPD患者动脉粥样硬化冠状动脉特征的数据。我们使用光学相干断层扫描（OCT）研究了患有急性冠状动脉综合征（ACS）的COPD患者的动脉粥样硬化冠状动脉斑块特征。对罪犯血管进行冠状动脉内OCT成像的ACS患者进行招募。通过OCT评估冠状动脉斑块特征和OCT定义的巨噬细胞浸润（MØI）。ACS患者根据确定的COPD诊断分为两组，两组之间比较了罪犯部位和罪犯血管沿线的斑块特征。146例ACS患者（平均年龄：66.1±12.7岁，109名男性），47例（32.2%）患有COPD。COPD患者的MØI患病率明显较高（78.7%vs.54.5%,p=0.005）和薄帽纤维粥样瘤（TCFA）（48.9%vs.22.2%,p=0.001）在罪犯地点。在多元逻辑回归中，COPD与罪犯部位的MØI(OR:21.209,CI95%:1.679;267.910,p=0.018)和TCFA独立相关(OR:5.345,CI95%:1.386;20.616,p=0.015)。同样，COPD与罪犯血管沿线的MØI（OR：3.570，CI95％：1.472；8.658，p=0.005）和TCFA（OR：4.088，CI95％：1.584；10.554，p=0.004）独立相关。总之,在接受罪犯血管OCT成像的ACS患者中，COPD是斑块炎症和易损性的独立预测因子。这些结果可能提示COPD患者的较高炎症环境可能会增强局部冠状动脉炎症。促进CAD的发展和斑块的脆弱性。
