目的:治疗后的斑块(HP)与快速的斑块生长和管腔狭窄有关。薄帽纤维粥样瘤(TCFA)被认为是斑块破裂的前兆病变。本研究的目的是比较光学相干断层扫描(OCT)衍生的HP之间的脂质大小,TCFA,使用近红外光谱-血管内超声(NIRS-IVUS)和厚帽纤维瘤(ThCFA)。
方法:本研究纳入了173例接受经皮冠状动脉介入治疗的急性心肌梗死(AMI)患者。通过OCT和NIRS-IVUS评估血管造影中度狭窄的非罪犯病变。
结果:TCFA的频率,HP,ThCFA为35(20%),53(30%),85(49%),分别。TCFA和HP之间的最小管腔面积没有显着差异,但TCFA和HP小于ThCFA(4.6[四分位数间距{IQR}:3.5-6.4]mm2vs.4.3[3.4-5.3]mm2vs.6.5[4.8-8.6]mm2,P<0.001)。TCFA和HP之间的斑块负担没有显着差异,但TCFA和HP大于ThCFA(72[IQR:66-80]%vs.75[67-80]%vs.62[54-69]%,P<0.001)。4mm的最大脂质核心负荷指数(maxLCBI4mm)在TCFA中最大,其次是HP和ThCFA(493[IQR:443-606]vs.446[347-520]vs.231[161-302],P<0.001)。在TCFA中,maxLCBI4mm>400的富脂斑块频率最高,其次是HP和ThCFA(89%vs.60%vs.7%,P<0.001)。
结论:基于NIRS-IVUS研究结果,AMI患者非罪犯冠状动脉HP与易损斑块特征相关,但没有TCFA那么多。
OBJECTIVE: Healed plaque (HP) is associated with rapid plaque growth and luminal narrowing. Thin-cap fibroatheroma (TCFA) is recognized as a precursor lesion to plaque rupture. The aim of the present study was to compare the lipid size among optical coherence tomography (OCT)-derived HP, TCFA, and thick-cap fibroatheroma (ThCFA) using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS).
METHODS: The present study included 173 patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention. Non-culprit lesions with angiographically intermediate stenosis were assessed by both OCT and NIRS-IVUS.
RESULTS: The frequency of TCFA, HP, and ThCFA was 35 (20%), 53 (30%), and 85 (49%), respectively. Minimum lumen area was not significantly different between TCFA and HP, but was smaller in TCFA and HP than in ThCFA (4.6 [interquartile range {IQR}: 3.5-6.4] mm2 vs. 4.3 [3.4-5.3] mm2 vs. 6.5 [4.8-8.6] mm2, P<0.001). Plaque burden was not significantly different between TCFA and HP, but was larger in TCFA and HP than in ThCFA (72 [IQR: 66-80] % vs. 75 [67-80] % vs. 62 [54-69] %, P<0.001). Maximum lipid core burden index in 4mm (maxLCBI4mm) was largest in TCFA, followed by HP and ThCFA (493 [IQR: 443-606] vs. 446 [347-520] vs. 231 [161-302], P<0.001). The frequency of lipid rich plaque with maxLCBI4mm >400 was highest in TCFA, followed by HP and ThCFA (89% vs. 60% vs. 7%, P<0.001).
CONCLUSIONS: Based on NIRS-IVUS findings, non-culprit coronary HP in AMI was associated with vulnerable plaque characteristics, but not as much as TCFA.