Calcified Plaques in Patients With Acute Coronary Syndromes
Calcified Plaques in Patients With Acute Coronary Syndromes
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DOI：
10.1016/j.jcin.2018.12.013
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发表时间：
2019-03-25
影响因子：
11.3
通讯作者：
Jang, Ik-Kyung
中科院分区：
文献类型：
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作者：
Sugiyama, Tomoyo;Yamamoto, Erika;Jang, Ik-Kyung
目的对急性冠脉综合征(ACS)患者的钙化斑块进行详细的分析。背景：钙化斑块是急性冠脉综合征(ACS)患者的基础病理，尚未有系统的研究。方法在1241例接受介入治疗前接受光学相干断层扫描的ACS患者中，157例(12.7%)患者的病变部位有钙化斑块。结果钙化斑块分为3种类型：爆发性钙化结节、浅层钙化片状钙化斑块和钙化隆起斑块，其发生率分别为25.5%、67.4%和7.1%。右冠状动脉多见爆发性钙化结节(44.4%)，左前降支多见浅层钙化片状(68.4%)(p=0.012)。钙化指数(平均钙化弧长)以爆发性钙化结节最大，其次为浅层钙化片状，钙化突起最小(中位数3,284.9[四分位数范围：2,113.3~5,385.3]vs 1,644.3[IQR：1,012.4~3,058.7]vs.472.5[IQR：176.7~865.2]；p<；0.001)。浅层钙化片组介入治疗后肌酸激酶峰值最高(爆发性钙化结节组、浅层钙化片组、钙化隆起组：241IQR116~612Iu/L vs.834[IQR141~3,394]IQR141~3,394]Iu/L vs.745[IQR69~1,984]IQR：69~1,984]IU/L；浅层钙化样常位于冠状动脉左前降支，是最常见的类型，也与介入治疗后最大的心肌损害有关。(NCT03479723)(C)2019年，美国心脏病学会基金会。
OBJECTIVES This study conducted detailed analysis of calcified culprit plaques in patients with acute coronary syndromes (ACS).BACKGROUND Calcified plaques as an underlying pathology in patients with ACS have not been systematically studied.METHODS From 1,241 patients presenting with ACS who had undergone pre-intervention optical coherence tomography imaging, 157 (12.7%) patients were found to have a calcified plaque at the culprit lesion. Calcified plaque was defined as a plaque with superficial calcification at the culprit site without evidence of ruptured lipid plaque.RESULTS Three distinct types were identified: eruptive calcified nodules, superficial calcific sheet, and calcified protrusion (prevalence of 25.5%, 67.4%, and 7.1%, respectively). Eruptive calcified nodules were frequently located in the right coronary arteries (44.4%), whereas superficial calcific sheet was most frequently found in the left anterior descending coronary arteries (68.4%) (p = 0.012). Calcification index (mean calcification arc x calcification length) was greatest in eruptive calcified nodules, followed by superficial calcific sheet, and smallest in calcified protrusion (median 3,284.9 [interquartile range (IQR): 2,113.3 to 5,385.3] vs. 1,644.3 [IQR: 1,012.4 to 3,058.7] vs. 472.5 [IQR: 176.7 to 865.2]; p < 0.001). The superficial calcific sheet group had the highest peak post-intervention creatine kinase values among the groups (eruptive calcified nodules vs. superficial calcific sheet vs. calcified protrusion: 241 [IQR: 116 to 612] IU/l vs. 834 [IQR: 141 to 3,394] IU/l vs. 745 [IQR: 69 to 1,984] IU/l; p = 0.032).CONCLUSIONS Three distinct types of calcified culprit plaques are identified in patients with ACS. Superficial calcific sheet, which is frequently located in the left anterior descending coronary artery, is the most prevalent type and is also associated with greatest post-intervention myocardial damage. (Identification of Predictors for Coronary Plaque Erosion in Patients With Acute Coronary Syndrome; NCT03479723) (c) 2019 by the American College of Cardiology Foundation.