Systemic and local factors associated with reduced thrombolysis in myocardial infarction flow in ST-segment elevation myocardial infarction patients with plaque erosion detected by intravascular optical coherence tomography
Systemic and local factors associated with reduced thrombolysis in myocardial infarction flow in ST-segment elevation myocardial infarction patients with plaque erosion detected by intravascular optical coherence tomography
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血管内光学相干断层扫描检测斑块侵蚀ST段抬高型心肌梗死患者心肌梗死血流溶栓减少的全身和局部因素
DOI：
10.1007/s10554-020-02021-1
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Bo Yu
中科院分区：
文献类型：
--
作者：
Jifei Wang;Chao Fang;Shaotao Zhang;Lulu Li;Jia Lu;Yidan Wang;Yini Wang;Huai Yu;Guo Wei;Yanwei Yin;Senqing Jiang;Junchen Guo;Fangmeng Lei;Huimin Liu;Maoen Xu;Xuefeng Ren;Lijia Ma;Yingfeng Tu;Lei Xing;Jingbo Hou;Jiannan Dai;Bo Yu
斑块破裂的局部因素（如脂质负荷）与直接经皮冠状动脉介入治疗（PCI）中心肌梗死前溶栓（TIMI）血流分级有关。然而，斑块侵蚀和破裂的病理机制不同。我们的目的是确定与斑块侵蚀中TIMI血流减少相关的因素。将329例经光学相干断层扫描（OCT）证实的ST段抬高型心肌梗死（STEMI）患者按术前TIMI血流分级分为2组[TIMI 0-1组（n = 219）和TIMI 2-3组（n = 110）]。TIMI 0-1级组患者年龄较大（> 50岁，68.5%vs51.8%，P = 0.003），合并糖尿病的比例较高（18.3%vs8.2%，P = 0.015）。TIMI血流0-1级斑块位于左前降支的比例较低（LAD，58.4%vs.72.7%，P = 0.011），位于右冠状动脉的比例较高（RCA，34.2%vs.7.3%，P = 0.001）。TIMI 0-1组脂质斑块（53.9%vs41.8%，P = 0.039）、巨噬细胞聚集（59.8%vs41.8%，P = 0.002）和钙化（34.2%vs21.8%，P = 0.020）明显增多。在多变量分析中，年龄> 50岁、糖尿病、RCA位置和巨噬细胞积聚是有斑块侵蚀的STEMI患者TIMI血流分级降低的独立预测因素。全身因素（老年和糖尿病）和局部因素（RCA位置和巨噬细胞积聚）与斑块侵蚀的STEMI患者的冠状动脉血流减少独立相关。临床试验registrationClinicalTrials.gov NCT 03084991 2017年5月17日（回顾性注册）。
AbstractLocal factors of plaque rupture (e.g. lipid burden) are related to preprocedural thrombolysis in myocardial infarction (TIMI) flow grade during primary percutaneous coronary intervention (PCI). However, the pathological mechanism differs between plaque erosion and rupture. We aimed to identify the factors associated with reduced TIMI flow in plaque erosion. A total of 329 ST-segment elevation myocardial infarction (STEMI) patients with optical coherence tomography (OCT) identified plaque erosion were divided into 2 groups by preprocedural TIMI flow grade [TIMI 0–1 group (n = 219) and TIMI 2–3 group (n = 110)]. Patients in TIMI 0–1 group were older (age > 50 years, 68.5% vs. 51.8%,P= 0.003), and had more diabetes mellitus (18.3% vs. 8.2%,P= 0.015). Plaque erosion with TIMI flow 0–1 was less frequently located in the left anterior descending artery (LAD, 58.4% vs. 72.7%,P= 0.011), but more frequently located in the right coronary artery (RCA, 34.2% vs. 7.3%,P= 0.001) than those with TIMI flow 2–3. TIMI 0–1 group had more lipid plaques (53.9% vs. 41.8%,P= 0.039), macrophage accumulation (59.8% vs. 41.8%,P= 0.002), and calcification (34.2% vs. 21.8%,P= 0.020). In the multivariable analysis, age > 50 years, diabetes mellitus, RCA location, and macrophage accumulation were the independent predictors of reduced TIMI flow grade in STEMI patients with plaque erosion. Systemic factors (older age and diabetes mellitus) and local factors (RCA location and macrophage accumulation) were independently associated with reduced coronary flow in STEMI patients with plaque erosion.Clinical trial registrationClinicalTrials.gov NCT03084991 May 17, 2017 (retrospectively registered).
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DOI：
10.1161/01.atv.0000131784.50633.4f
发表时间：
2004-07-01
影响因子：
8.7
作者：
Sugiyama, S;Kugiyama, K;Libby, P
通讯作者：
Libby, P
影响因子：
5.7
作者：
Bainey, K. R.;Fu, Y.;Armstrong, P. W.
通讯作者：
Armstrong, P. W.
影响因子：
105.7
作者：
MEADE, TW;VICKERS, MV;MILLER, GJ
通讯作者：
MILLER, GJ
影响因子：
11.3
作者：
Ino, Yasushi;Kubo, Takashi;Akasaka, Takashi
通讯作者：
Akasaka, Takashi
影响因子：
11.3
作者：
Toutouzas, Konstantinos;Tsiamis, Elefterios;Stefanadis, Christodoulos
通讯作者：
Stefanadis, Christodoulos