Colocalization of thin-cap fibroatheroma and spotty calcification is a powerful predictor of procedure-related myocardial injury after elective coronary stent implantation.
Colocalization of thin-cap fibroatheroma and spotty calcification is a powerful predictor of procedure-related myocardial injury after elective coronary stent implantation.
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薄帽纤维粥样斑块和点状钙化的共定位是择期冠状动脉支架植入后手术相关心肌损伤的有力预测因子。
DOI：
10.1097/mca.0000000000000114
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Saito Y.
中科院分区：
文献类型：
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作者：
Ueda T;Uemura S;Watanabe M;Sugawara Y;Soeda T;Okayama S;Takeda Y;Kawata H;Kawakami R;Saito Y.
目的经皮冠状动脉介入治疗（PCI）相关心肌酶升高是不良临床结局的独立危险因素，但该并发症的术前预测因素尚未建立。本研究通过频域光学相干断层扫描（FD-OCT）评估罪犯病变的形态学特征，并检查其对接受择期PCI的患者中手术相关心肌损伤的预测价值。方法研究了68例接受FD-OCT引导的择期PCI治疗的患者。根据是否存在术后血浆心肌肌钙蛋白T（cTnT）升高，将患者分为升高组（cTnT-E，n= 25）和非升高组（cTnT-nonE，n= 43）。罪犯病变的FD-OCT检查支架植入前后进行，和组织特征进行了评价内10毫米长的段每个lesions.ResultsClinical参数两组之间是相似的。cTnT-E组的支架长度显著长于cTnT-nonE组。在基线OCT图像上，与cTnT-nonE组相比，cTnT-E组罪犯节段内更常观察到薄帽纤维粥样硬化和钙沉积（分别为32.0 vs. 11.6%，P= 0.043和72.0 vs. 46.5%，P= 0.039）。此外，这两种结果的共定位是PCI相关cTnT升高的有力预测因素（比值比8.40，95%置信区间1.65-52.78，P< 0.01）。此外，当分析仅包括斑点状钙化时，这种共定位的预测价值得到增强（比值比21.00，95%置信区间2.65-454.22，P= 0.003）。结论FD-OCT检查显示，薄帽纤维粥样硬化和斑点状钙化的共定位是PCI相关cTnT升高的有力预测因子。FD-OCT可用于PCI期间的风险分层，以避免手术相关并发症。
ObjectivesPercutaneous coronary intervention (PCI)-related cardiac enzyme elevation is an independent risk factor for adverse clinical outcomes, but preprocedural predictors of this complication have not been established. This study evaluated the morphological characteristics of culprit lesions by frequency-domain optical coherence tomography (FD-OCT), and examined their predictive value for procedure-related myocardial injury in patients undergoing elective PCI.MethodsSixty-eight patients treated by FD-OCT-guided elective PCI were studied. On the basis of the presence or absence of postprocedural plasma cardiac troponin T (cTnT) elevation, patients were divided into elevation (cTnT-E, n= 25) and nonelevation (cTnT-nonE, n= 43) groups. FD-OCT examinations of culprit lesions were performed before and after stent implantation, and tissue characteristics were evaluated within a 10-mm-long segment of each lesion.ResultsClinical parameters were similar between the two groups. Stent length was significantly longer in the cTnT-E group than in the cTnT-nonE group. On baseline OCT images, thin-cap fibroatheroma and calcium deposition were more frequently observed within culprit segments of the cTnT-E group compared with the cTnT-nonE group (32.0 vs. 11.6%, P= 0.043, and 72.0 vs. 46.5%, P= 0.039, respectively). In addition, colocalization of these two findings was a powerful predictor of PCI-related cTnT elevation (odds ratio 8.40, 95% confidence interval 1.65–52.78, P< 0.01). Further, the predictive value of this colocalization was enhanced when the analysis included only spotty calcification (odds ratio 21.00, 95% confidence interval 2.65–454.22, P= 0.003).ConclusionFD-OCT examination showed that colocalization of thin-cap fibroatheroma and spotty calcification was a powerful predictor of PCI-related cTnT elevation. FD-OCT is useful for stratifying risk during PCI to avoid procedure-related complications.