Number of yellow plaques detected in a coronary artery is associated with future risk of acute coronary syndrome - Detection of vulnerable patients by angioscopy
Number of yellow plaques detected in a coronary artery is associated with future risk of acute coronary syndrome - Detection of vulnerable patients by angioscopy
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DOI：
10.1016/j.jacc.2006.01.064
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发表时间：
2006-06-06
影响因子：
24
通讯作者：
Kodama, Kazuhisa
中科院分区：
文献类型：
--
作者：
Ohtani, Tomohito;Ueda, Yasunori;Kodama, Kazuhisa
目的探讨血管内窥镜检查是否可以评估急性冠脉综合征(ACS)的风险。背景易损斑块破裂和继发血栓形成被认为是ACS的主要机制。虽然黄色斑块被认为是脆弱的，但血管内窥镜检查确定的冠状动脉粥样硬化程度与ACS事件的风险之间的关联尚未被报道。方法前瞻性地纳入接受冠状动脉插管和血管内窥镜检查以诊断冠状动脉疾病的患者(n=552)，并对其进行新的ACS事件的随访。根据标准颜色将所有检测到的黄色斑块的黄色强度分为1、2、3级。测定冠状动脉内黄色斑块数目(NYP)和检测到的黄色斑块的最大色度(MaxYP)。结果随访时间为57.3+/-22.1个月。39例(7.1%)患者发生了急性冠状动脉综合征事件。尽管MaxYP无统计学差异(2.0+/-0.7vs.1.8+/-0.9；p=0.18)，但有急性冠脉综合征事件的患者的NYT高于未发生该事件的患者(3.1+/-1.8vs.2.2+/-1.5；p=0.008)。NYP>；=2和NYP>；=5的患者的事件发生率分别是NYP为0或1的患者的2.2和3.8倍(分别为9.0%和15.6%，分别为4.1%；p=0.02)。多因素Logistic回归分析显示，NYP和多支血管病变是发生ACS事件的独立危险因素。结论每支血管有多个黄色斑块的患者发生ACS事件的风险高于NYP为0或1的患者。血管内窥镜检查有助于发现易受感染的患者。
OBJECTIVES We sought to test whether the risk of acute coronary syndrome (ACS) can be estimated by angioscopy.BACKGROUND Disruption of vulnerable plaque and subsequent thrombosis is regarded as a major mechanism of ACS. Although yellow plaques are supposedly vulnerable, the association between angioscopically determined extent of coronary atherosclerosis and risk of ACS events has not been reported.METHODS Patients (n = 552) who received catheterization and angioscopic examination for the diagnosis of coronary artery diseases were prospectively included and followed up for new onset of ACS events. Yellow color intensities of all detected yellow plaques were graded as 1, 2, or 3 according to the standard colors. Number of yellow plaques (NYP) in a coronary artery and maximum color grade of detected yellow plaques (maxYP) were determined. Association between the incidence of ACS events and angioscopic findings were analyzed.RESULTS Follow-up interval was 57.3 +/- 22.1 months. Acute coronary syndrome events were detected in 39 patients (7.1%). Although maxYP was not statistically different (2.0 +/- 0.7 vs. 1.8 +/- 0.9; p = 0.18), NYT was higher in the patients with an ACS event than those without the event (3.1 +/- 1.8 vs. 2.2 +/- 1.5; p = 0.008). Patients with NYP >= 2 and those with NYP >= 5 had 2.2- and 3.8-fold higher event rates, respectively, than those with NYP 0 or 1 (9.0% and 15.6%, respectively, vs. 4.1%; p = 0.02). Multivariate logistic regression analysis revealed NYP and multivessel disease as the independent risk factors of ACS events.CONCLUSIONS Patients with multiple yellow plaques per vessel have a higher risk of suffiering ACS events than those with NYP 0 or 1. Angioscopy would be useful to detect vulnerable patients.