目的:有癌症史的急性冠状动脉综合征(ACS)患者的患病率正在增加,并且与较高的死亡率相关。然而,关于有癌症史的ACS患者冠状动脉斑块特征的证据有限.本研究通过光学相干断层扫描(OCT)探讨有癌症史的ACS患者的全冠状动脉斑块特征。
方法:纳入了在经皮冠状动脉介入治疗(PCI)时接受3血管OCT治疗的306例ACS患者,回顾性。根据是否有癌症病史将患者分为两组:一组有癌症病史(n=98)和一组没有癌症病史(n=208)。
结果:在本研究中,OCT共发现314个罪犯病变和514个非罪犯病变。在罪魁祸首病变中,有癌症史的ACS患者有较高的细帽纤维粥样硬化(TCFA)发生率(p=0.016),胆固醇晶体(p=0.028),钙化(p=0.001)和血栓(p=0.001),并且具有较薄的纤维帽厚度(FCT)(p=0.011),更大的最大脂质弧(p=0.042)和脂质指数(p<0.001),与没有癌症史的ACS患者进行比较。在非罪犯病变中,有癌症史的ACS患者的高危斑块患病率较高(14.7%vs.7.7%,p=0.017),罪魁祸首破裂(14.7%vs.6.3%,p=0.003),和TCFA(52.2%与28.3%,p<0.001),钙化发生率较高(p=0.003),血栓(p=0.029),胆固醇晶体(p=0.002)和微通道(p=0.029)。这些非罪犯病变的病变长度较长(p=0.001),较薄的FCT(p<0.001),更大的最大脂质弧(p=0.016)和脂质指数(p<0.001)。
结论:有癌症史的ACS患者在罪犯和非罪犯病变中显示出更多的高危斑块特征,与无癌症史的ACS患者相比。因此,有癌症病史的ACS患者可能具有更大的全冠状动脉脆弱性。这可能预测有癌症史的ACS患者预后较差。
The prevalence of acute coronary syndrome (ACS) patients with cancer history is increasing and it is associated with higher mortality. However, there is limited evidence on the characteristics of coronary plaque in ACS patients with cancer history. This study explored the pancoronary plaque characteristics in ACS patients with cancer history by optical coherence tomography (OCT).
A total of 306 ACS patients treated by 3-vessel OCT at the time of percutaneous coronary intervention (PCI) were included, retrospectively. Patients were divided into two groups according to the presence or absence of cancer history: one group with cancer history (n = 98) and a matched group without cancer history (n = 208).
A total of 314 culprit lesions and 514 nonculprit lesions were identified by OCT in this study. In culprit lesions, ACS patients with cancer history had higher incidence of thin cap fibroatheroma (TCFA) (p = 0.016), cholesterol crystals (p = 0.028), calcification (p = 0.001) and thrombus (p = 0.001), and had thinner fibrous cap thickness (FCT) (p = 0.011), greater maximum lipid arc (p = 0.042) and lipid index (p < 0.001), compared to matched ACS patients without cancer history. In nonculprit lesions, ACS patients with cancer history had higher prevalence of high-risk plaque (14.7% vs. 7.7%, p = 0.017), nonculprit rupture (14.7% vs. 6.3%, p = 0.003), and TCFA (52.2% vs. 28.3%, p < 0.001), and had higher incidence of calcification (p = 0.003), thrombus (p = 0.029), cholesterol crystals (p = 0.002) and microchannels (p = 0.029). These non-culprit lesions had longer lesion length (p = 0.001), thinner FCT (p < 0.001), greater maximum lipid arc (p = 0.016) and lipid index (p < 0.001).
ACS patients with cancer history showed more high-risk plaque features in culprit and nonculprit lesions, compared with ACS patients without cancer history. Therefore, ACS patients with cancer history may have greater pancoronary vulnerability. This may predict a poorer prognosis for ACS patients with cancer history.