Prevalence of low-attenuation plaques and statin therapy in plaque rupture type of acute coronary syndrome
Prevalence of low-attenuation plaques and statin therapy in plaque rupture type of acute coronary syndrome
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斑块破裂型急性冠状动脉综合征中低衰减斑块的患病率和他汀类药物治疗
DOI：
10.1097/mca.0000000000001203
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发表时间：
2022
影响因子：
1.8
通讯作者：
Tanaka Atsushi
中科院分区：
文献类型：
--
作者：
Kashiwagi Manabu;Taruya Akira;Kuroi Akio;Katayama Yosuke;Terada Kosei;Wada Teruaki;Takahata Masahiro;Shiono Yasutsugu;Tanimoto Takashi;Tanaka Atsushi
本研究旨在探讨急性冠脉综合征（ACS）和稳定型缺血性心脏病（SIHD）在冠状动脉ct血管造影（CCTA）和药物治疗方面的差异。我们还探讨了ACS初期CCTA斑块形态与急性期病变形态之间的关系。方法入选5967例有创冠状动脉造影患者，其中58例ACS患者和91例SIHD患者既往有罪魁祸首病变CCTA成像，CCTA扫描否认缺血性心脏病。结果ACS组阳性重构发生率无显著差异（P= 0.27），但ACS组低衰减斑块（LAP）发生率明显高于SIHD组（52% vs. 24%， P< 0.01）。两组患者冠脉狭窄分级频率无差异（P= 0.14）。在ACS患者中，通过光学相干断层扫描（OCT）评估斑块破裂和富脂斑块的频率，LAP组明显高于非LAP组（73% vs. 23%， P< 0.01; 82% vs. 23%， P< 0.01）。多因素回归分析显示，他汀类药物的使用和既往CCTA的LAP是未来ACS事件的预测因子（P< 0.01， P< 0.05）。结论CCTA上的slap，非阳性动脉重塑，以及缺乏他汀类药物治疗与ACS的发展有关。此外，与非LAP相比，LAP更容易导致斑块破裂型ACS的发展。无论冠状动脉狭窄与否，他汀类药物降脂治疗可能有助于预防LAP患者斑块破裂。
BackgroundWe sought to investigate the differences in coronary plaque morphology on coronary computed tomography angiography (CCTA) and medical therapy between acute coronary syndrome (ACS) and stable ischemic heart disease (SIHD). We also explored the relationship between plaque morphology on CCTA at the initial phase and lesion morphology in the acute phase of ACS.MethodsIn 5967 patients who underwent invasive coronary angiography, 58 ACS and 91 SIHD patients who had prior CCTA imaging of the culprit lesion and denied ischemic heart disease at CCTA scanning were enrolled.ResultsAlthough the prevalence of positive remodeling was not different (P= 0.27), low-attenuation plaques (LAP) on prior CCTA were significantly higher in ACS than in SIHD (52% vs. 24%, P< 0.01). The frequency of coronary stenosis grading did not differ between the two groups (P= 0.14). In ACS patients, the frequencies of plaque rupture and lipid-rich plaque assessed by optical coherence tomography (OCT) were significantly higher in LAP than in non-LAP (73% vs. 23%, P< 0.01; 82% and 23%, P< 0.01). Multivariate regression analysis revealed that statin use and LAP on prior CCTA were predictors of future ACS events (P< 0.01, and P< 0.05, respectively).ConclusionsLAP on CCTA, not positive arterial remodeling, and lack of statin therapy were associated with ACS development. In addition, LAP more frequently led to the development of the plaque rupture type of ACS compared with non-LAP. Lipid-lowering therapy with statins might be useful to prevent plaque rupture in patients with LAP regardless of coronary stenosis.
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影响因子：
6.2
作者：
Deseive, Simon;Kupke, Maximilian;Hausleiter, Joerg
通讯作者：
Hausleiter, Joerg
影响因子：
39.3
作者：
Fairbairn TA;Nieman K;Akasaka T;Nørgaard BL;Berman DS;Raff G;Hurwitz-Koweek LM;Pontone G;Kawasaki T;Sand NP;Jensen JM;Amano T;Poon M;Øvrehus K;Sonck J;Rabbat M;Mullen S;De Bruyne B;Rogers C;Matsuo H;Bax JJ;Leipsic J;Patel MR
通讯作者：
Patel MR
影响因子：
8.7
作者：
Virmani, R;Kolodgie, FD;Schwartz, SM
通讯作者：
Schwartz, SM
影响因子：
14
作者：
Lee, Sang-Eun;Chang, Hyuk-Jae;Min, James K.
通讯作者：
Min, James K.
影响因子：
24
作者：
Hoffmann, U;Moselewski, F;Brady, TJ
通讯作者：
Brady, TJ