背景:ST段抬高型心肌梗死(STEMI)后释放的载脂斑块物质可能导致无复流现象。这项研究的目的是研究通过光学相干断层扫描(OCT)检测到的体内胆固醇晶体(CC)与急性STEMI患者成功经皮冠状动脉介入治疗(PCI)后的无复流现象之间的关系。
方法:我们调查了182例STEMI患者。根据PCI术后心肌梗死溶栓(TIMI)血流分级,将患者分为无复流组(n=31)和复流组(n=151)。在OCT上,CC被定义为薄的,斑块内的高信号强度区域。进行了多变量逻辑回归分析以确定无复流现象的预测因子。
结果:无复流组的CC患病率高于复流组(无复流组,77%vs.回流组,53%;p=0.012)。多变量Logistic模型表明,CC数,脂质弧和口病变是无复流的阳性独立预测因子.脂质弧≥139°和CC数≥12的组合显示出对无回流现象的良好预测性能(灵敏度,48%;特异性,93%;和准确性,86%)。
结论:在STEMI患者PCI术后,罪犯斑块处的体内CC与无复流现象相关。CC数和脂质弧的组合可以预测PCI后的无复流现象,准确率高达86%。
BACKGROUND: The release of lipid-laden plaque material subsequent to ST-segment elevation myocardial infarction (STEMI) may contribute to the no-reflow phenomenon. The aim of this study was to investigate the association between in vivo cholesterol crystals (CCs) detected by optical coherence tomography (OCT) and the no-reflow phenomenon after successful percutaneous coronary intervention (PCI) in patients with acute STEMI.
METHODS: We investigated 182 patients with STEMI. Based on the thrombolysis in myocardial infarction (TIMI) flow grade after PCI, patients were divided into a no-reflow group (n = 31) and a reflow group (n = 151). On OCT, CCs were defined as thin, high-signal intensity regions within a plaque. A multivariable logistic regression analysis was performed to determine predictors for the no-reflow phenomenon.
RESULTS: The prevalence of CCs was higher in the no-reflow group than the reflow group (no-reflow group, 77% vs. reflow group, 53%; p = 0.012). The multivariable logistic model showed that the CC number, lipid arc and ostial lesions were positive independent predictors of no-reflow. The combination of a lipid arc ≥ 139°and CC number ≥ 12 showed good predictive performance for the no-reflow phenomenon (sensitivity, 48%; specificity, 93%; and accuracy, 86%).
CONCLUSIONS: In vivo CCs at the culprit plaque are associated with the no-reflow phenomenon after PCI in patients with STEMI. The combination of the number of CCs and lipid arc can predict the no-reflow phenomenon after PCI with a high accuracy of 86%.