Frequency, Predictors, Distribution, and Morphological Characteristics of Layered Culprit and Nonculprit Plaques of Patients With Acute Myocardial Infarction In Vivo 3-Vessel Optical Coherence Tomography Study
Frequency, Predictors, Distribution, and Morphological Characteristics of Layered Culprit and Nonculprit Plaques of Patients With Acute Myocardial Infarction In Vivo 3-Vessel Optical Coherence Tomography Study
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DOI：
10.1161/circinterventions.120.009125
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发表时间：
2020-10-01
影响因子：
5.6
通讯作者：
Yu, Bo
中科院分区：
文献类型：
--
作者：
Dai, Jiannan;Fang, Chao;Yu, Bo
背景：亚临床动脉粥样硬化血栓形成和斑块愈合可能导致斑块快速进展。当使用光学相干断层扫描成像时，组织病理学愈合的斑块具有分层外观。我们评估的频率，预测因素，分布和光学相干断层扫描分层罪犯和非罪犯斑块的形态特征，在急性心肌梗死patients with acute myocardial infarction.Methods：一个前瞻性系列的325例急性心肌梗死患者进行了光学相干断层扫描成像的所有3个本地冠状动脉。分层斑块表型有异质性的信号丰富的分层组织位于靠近管腔表面，清楚地划分从潜在plaic.Results：分层斑块检测到74.5%的急性心肌梗死患者。分层罪犯斑块的患者有更多的分层非罪犯斑块，他们更经常有梗死前心绞痛，ST段抬高型心肌梗死，高低密度脂蛋白胆固醇和缺乏抗血小板治疗。分层斑块多集中于左前降支和左旋支近段，而右冠状动脉分布较均匀。与非分层斑块相比，分层斑块在罪犯和非罪犯部位的光学相干断层扫描管腔面积狭窄更大。分层斑块表型的频率（P=0.038）和分层组织的最大面积（P 0.001）增加，从非罪犯薄帽纤维粥样硬化，非罪犯破裂罪犯rupture.Conclusions：分层斑块被确定在3-四分之一的急性心肌梗死患者，特别是在罪犯斑块的ST段抬高型心肌梗死患者。分层斑块在左前降支和左回旋支中分布有限，但在右冠状动脉中分布更均匀，其特征在于罪犯和非罪犯部位的管腔狭窄程度更大。
Background:Subclinical atherothrombosis and plaque healing may lead to rapid plaque progression. The histopathologic healed plaque has a layered appearance when imaged using optical coherence tomography. We assessed the frequency, predictors, distribution, and morphological characteristics of optical coherence tomography layered culprit and nonculprit plaques in patients with acute myocardial infarction.Methods:A prospective series of 325 patients with acute myocardial infarction underwent optical coherence tomography imaging of all 3 native coronary arteries. Layered plaque phenotype had heterogeneous signal-rich layered tissue located close to the luminal surface that was clearly demarcated from the underlying plaque.Results:Layered plaques were detected in 74.5% of patients with acute myocardial infarction. Patients with layered culprit plaques had more layered nonculprit plaques; and they more often had preinfarction angina, ST-segment-elevation myocardial infarction, higher low-density lipoprotein cholesterol, and absence of antiplatelet therapy. Layered plaques tended to cluster in the proximal segment of the left anterior descending artery and left circumflex artery but were more uniformly distributed in the right coronary artery. As compared with nonlayered plaques, layered plaques had greater optical coherence tomography lumen area stenosis at both culprit and nonculprit sites. The frequency of layered plaque phenotype (P=0.038) and maximum area of layered tissue (P0.001) increased from nonculprit thin-cap fibroatheromas to nonculprit ruptures to culprit ruptures.Conclusions:Layered plaques were identified in 3-quarters of patients with acute myocardial infarction, especially in the culprit plaques of patients with ST-segment-elevation myocardial infarction. Layered plaques had a limited, focal distribution in the left anterior descending artery, and left circumflex artery but were more evenly distributed in the right coronary artery and were characterized by greater lumen narrowing at both culprit and nonculprit sites.