In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study
In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study
复制标题
ST 段抬高型心肌梗死患者斑块侵蚀的体内预测因素：临床、血管造影和血管内光学相干断层扫描研究
DOI：
10.1093/eurheartj/ehy101
复制
发表时间：
2018-06-07
影响因子：
39.3
通讯作者：
Yu, Bo
中科院分区：
文献类型：
--
作者：
Dai, Jiannan;Xing, Lei;Yu, Bo
目的斑块侵蚀是急性冠状动脉血栓形成的重要基础。本研究旨在确定st段抬高型心肌梗死（STEMI）患者斑块侵蚀的体内预测因素。方法和结果对822例STEMI患者进行干预前光学相干断层扫描。根据已建立的诊断标准，209例有菌斑侵蚀（25.4%），564例有菌斑破裂（68.6%）。菌斑侵蚀在50岁女性中更为常见（P = 0.009）。在男性中也有类似的趋势，但没有那么明显（P = 0.011）。与斑块破裂的患者相比，斑块糜烂的患者更多是吸烟者，但其他冠状动脉危险因素（血脂异常、高血压、慢性肾病和糖尿病）较少。斑块糜烂主要发生在左前降支（LAD, 61.2%），而斑块破裂在前降支（LAD, 47.0%）和右冠状动脉（43.3%）中分布更为均匀。尽管侵蚀和破裂在冠状动脉长度上的空间分布相似，但斑块侵蚀在分叉附近发生的频率更高（P < 0.001）。在多变量分析中，年龄< 50岁、目前吸烟、无其他冠状动脉危险因素、无多血管病变、病变严重程度降低、血管尺寸较大、附近分叉与斑块侵蚀显著相关。附近分叉和当前吸烟在男性中尤为显著，而年龄< 50岁的女性最具预测性。结论在STEMI患者中，斑块侵蚀是一种可预测的临床实体，不同于斑块破裂，应考虑不同性别的危险因素在斑块侵蚀中的作用。
Aims Plaque erosion is a significant substrate of acute coronary thrombosis. This study sought to determine in vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction (STEMI).Methods and results A prospective series of 822 STEMI patients underwent pre-intervention optical coherence tomography. Using established diagnostic criteria, 209 had plaque erosion (25.4%) and 564 had plaque rupture (68.6%). Plaque erosion was more frequent in women = 50 years of age (P = 0.009). There was a similar, but less striking, trend in men (P = 0.011). Patients with plaque erosion were more frequently current smokers but had fewer other coronary risk factors (dyslipidaemia, hypertension, chronic kidney disease, and diabetes mellitus) than those with plaque rupture. There was a preponderance of plaque erosion in the left anterior descending artery (LAD; 61.2%), whereas plaque rupture was more equally distributed in both the LAD (47.0%) and right coronary artery (43.3%). Despite the similar spatial distribution of erosions and ruptures over the lengths of the coronary arteries, plaque erosion occurred more frequently near a bifurcation (P < 0.001). In the multivariable analysis, age < 50 years, current smoking, absence of other coronary risk factors, lack of multi-vessel disease, reduced lesion severity, larger vessel size, and nearby bifurcation were significantly associated with plaque erosion. Nearby bifurcation and current smoking were especially notable in men, while age < 50 years was most predictive in women.Conclusions Plaque erosion was a predictable clinical entity distinct from plaque rupture in STEMI patients, and gender-specific role of risk factors in plaque erosion should be considered.