Distinct Morphological Features of Ruptured Culprit Plaque for Acute Coronary Events Compared to Those With Silent Rupture and Thin-Cap Fibroatheroma A Combined Optical Coherence Tomography and Intravascular Ultrasound Study
Distinct Morphological Features of Ruptured Culprit Plaque for Acute Coronary Events Compared to Those With Silent Rupture and Thin-Cap Fibroatheroma A Combined Optical Coherence Tomography and Intravascular Ultrasound Study
复制标题
与无症状破裂和薄帽纤维粥样斑块相比，急性冠状动脉事件破裂罪魁祸首的独特形态学特征：光学相干断层扫描和血管内超声相结合的研究。
DOI：
10.1016/j.jacc.2014.01.061
复制
发表时间：
2014-06-03
影响因子：
24
通讯作者：
Jang, Ik-Kyung
中科院分区：
文献类型：
--
作者：
Tian, Jinwei;Ren, Xuefeng;Jang, Ik-Kyung
目的探讨急性冠状动脉综合征（acute coronary syndrome，ACS）患者中罪犯斑块破裂（ruptured criminal plaques，RCP）的形态特征，并与非罪犯斑块破裂（ruptured non-criminal plaques，RNCP）和非破裂薄帽纤维粥样硬化（non-ruptured thin-cap fibroatheroma，TCFA）进行比较。目前尚不清楚是否某些形态特征决定TCFA破裂，随后导致ACS.Methods我们分析了126斑块（RCP 49，RNCP 19，TCFA 58）从82例ACS患者使用光学相干断层扫描（OCT）和血管内超声（IVUS）。结果纤维帽在RCP组（43 ± 11 μ m）和RNCP组（41 ± 10 μ m）较TCFA组（56 ± 9 μ m）薄（分别为P < 0.001和P < 0.001）。与RNCP（64 +/-7.2%，p < 0.001）和TCFA（62 +/-12.5%，p < 0.001）相比，RCP（82 +/- 7.2%）的斑块负荷更大。与RNCP（4.6 +/- 2.3 mm（2），p 0.001）和TCFA（5.1 +/- 2.7 mm（2），p < 0.001）相比，RCP（2.1 +/- 0.9 mm（2））的管腔面积较小。纤维帽厚度< 52 mm在区分破裂斑块和TCFA方面具有良好的性能（曲线下面积[AUC] 0.857，p < 0.001）、斑块负荷>76%和管腔面积< 2.6 mm（2）在区分RCP与RNCP和TCFA方面具有良好的性能结论纤维帽厚度是判断破裂斑块与未破裂TCFA的重要形态学指标，斑块负荷和管腔面积是RCP的重要形态学指标。这些发现表明，斑块破裂由纤维帽厚度决定，大斑块负荷和管腔狭窄共同导致ACS。(C)2014年美国心脏病学会基金会
Objectives The study sought to identify specific morphological characteristics of ruptured culprit plaques (RCP) responsible for acute events, and compare them with ruptured nonculprit plaques (RNCP) and nonruptured thin-cap fibroatheroma (TCFA) in patients presenting with acute coronary syndromes (ACS).Background Nonruptured TCFA and multiple ruptured plaques are detected in the same patients with ACS. It remains unknown whether certain morphological characteristics determine rupture of TCFA and subsequently result in ACS.Methods We analyzed 126 plaques (RCP 49, RNCP 19, TCFA 58) from 82 ACS patients using optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Fibrous cap thickness was determined by OCT. Plaque burden and lumen area were measured with IVUS.Results Fibrous cap was thinner in RCP (43 +/- 11 mu m) and RNCP (41 +/- 10 mu m) than in TCFA (56 +/- 9 mu m, p < 0.001 and p < 0.001, respectively). Plaque burden was greater in RCP (82 +/- 7.2%), compared with RNCP (64 +/- 7.2%, p < 0.001) and TCFA (62 +/- 12.5%, p < 0.001). Lumen area was smaller in RCP (2.1 +/- 0.9 mm(2)), compared with RNCP (4.6 +/- 2.3 mm(2), p 0.001) and TCFA (5.1 +/- 2.7 mm(2), p < 0.001). The fibrous cap thickness < 52 mm had good performance in discriminating ruptured plaque from TCFA (area under the curve [AUC] 0.857, p < 0.001), and plaque burden >76% and lumen area < 2.6 mm(2) had good performance in discriminating RCP from RNCP and TCFA (AUC 0.923, p < 0.001 and AUC 0.881, p < 0.001, respectively).Conclusions Fibrous cap thickness is a critical morphological discriminator between ruptured plaques and nonruptured TCFA, while plaque burden and lumen area appear to be important morphological features of RCP. These findings suggest that plaque rupture is determined by fibrous cap thickness, and a combination of large plaque burden and luminal narrowing result in ACS. (C) 2014 by the American College of Cardiology Foundation