Morphology of Exertion-Triggered Plaque Rupture in Patients With Acute Coronary Syndrome An Optical Coherence Tomography Study
Morphology of Exertion-Triggered Plaque Rupture in Patients With Acute Coronary Syndrome An Optical Coherence Tomography Study
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DOI：
10.1161/circulationaha.108.782540
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发表时间：
2008-12-02
期刊：
影响因子：
37.8
通讯作者：
Akasaka, Takashi
中科院分区：
文献类型：
--
作者：
Tanaka, Atsushi;Imanishi, Toshio;Akasaka, Takashi
背景：斑块破裂和继发性血栓形成在急性冠脉综合征（ACS）的发病中起关键作用。一项病理研究表明，在经历猝死的男性中，静息性和劳损性斑块破裂的形态不同。本研究的目的是利用光学相干断层扫描来研究ACS患者在ACS发病时破裂斑块的形态与患者活动之间的关系。方法和结果：研究人群来自43例连续的ACS患者（有或没有st段抬高），这些患者接受了光学相干断层扫描，并在罪魁祸首部位出现了破裂的斑块。根据ACS发病时的活动量将患者分为休息组和运动组。断裂纤维帽的厚度与ACS发病时的活性呈正相关。运动组的罪魁祸首斑块在肩部破裂的频率高于休息组（休息57% vs运动93%，P = 0.014）。运动组纤维帽断裂厚度显著高于休息开始组（休息开始：50 μ m[四分位数间隔15 μ m]；运动开始：90 μ m[四分位数间隔65 μ m]， P < 0.01）。结论：ACS患者的劳损性和静息性破裂斑块形态不同。我们的数据表明，薄帽纤维动脉粥样瘤是一种易于在休息和患者日常活动中破裂的病变，而厚纤维帽可能发生斑块破裂，这取决于运动水平。（Circulation. 2008; 118: 2368-2373.）
Background-Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men who experienced sudden death. The aim of the present study was to use optical coherence tomography to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient's activity at the onset of ACS.Methods and Results-The study population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent optical coherence tomography and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. The thickness of the broken fibrous cap correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% versus exertion 93%, P = 0.014). The thickness of the broken fibrous cap in the exertion group was significantly higher than in the rest-onset group (rest onset: 50 mu m [interquartile median 15 mu m]; exertion: 90 mu m [interquartile median 65 mu m], P < 0.01).Conclusions-The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest and during the patient's day-to day activity, and some plaque rupture may occur in thick fibrous caps depending on exertion levels. (Circulation. 2008; 118: 2368-2373.)