Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Acute Coronary Syndrome An Optical Coherence Tomography Study
Difference of Culprit Lesion Morphologies Between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Acute Coronary Syndrome An Optical Coherence Tomography Study
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DOI：
10.1016/j.jcin.2010.09.022
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发表时间：
2011-01-01
影响因子：
11.3
通讯作者：
Akasaka, Takashi
中科院分区：
文献类型：
--
作者：
Ino, Yasushi;Kubo, Takashi;Akasaka, Takashi
目的探讨ST段抬高型心肌梗死（STEMI）与非ST段抬高型急性冠状动脉综合征（NSTEACS）患者冠状动脉病变的光学相干断层扫描（OCT）特征。光学相干断层扫描是一种高分辨率的成像方式，能够在体内研究详细的冠状动脉斑块形态。方法我们通过OCT检查了89例急性冠状动脉综合征患者的罪犯病变形态（STEMI = 40; NSTEACS = 49）。结果斑块破裂、薄帽纤维粥样硬化、STEMI中红色血栓的发生率显著高于NSTEACS（分别为70% vs. 47%，p = 0.033，78% vs. 49%，p = 0.008和78% vs. 27%，p < 0.001）。虽然两组斑块破裂部位的管腔面积相似，（2.44 +/- 1.34 mm（2）vs. 2.96 +/- 1.91 mm（2），p = 0.250），STEMI的破裂腔面积显著大于NSTEACS（2.52 ± 1.36 mm（2）vs. 1.67 ± 1.37 mm（2），p = 0.034）。STEMI患者冠状动脉内破裂斑块的开口与冠状动脉血流方向相反的比例明显高于NSTEACS患者（46%vs.17%，p = 0.036）。斑块破裂和冠状动脉内血栓的形态学特征可能与急性冠状动脉疾病患者的临床表现有关。（J Am科尔Cardiol Intv 2011;4：76-82）（C）美国心脏病学会基金会2011年
Objectives The aim of this study was to investigate the difference of culprit lesion morphologies assessed by optical coherence tomography (OCT) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTEACS).Background Autopsy studies have reported that rupture of a thin-cap fibroatheroma and subsequent thrombus formation is the most important mechanism leading to acute coronary syndrome (ACS). Optical coherence tomography is a high-resolution imaging modality that is capable of investigating detailed coronary plaque morphology in vivo.Methods We examined the culprit lesion morphologies by OCT in 89 consecutive patients with acute coronary syndrome (STEMI = 40; NSTEACS = 49).Results The incidence of plaque rupture, thin-cap fibroatheroma, and red thrombus was significantly higher in STEMI compared with NSTEACS (70% vs. 47%, p = 0.033, 78% vs. 49%, p = 0.008, and 78% vs. 27%, p < 0.001, respectively). Although the lumen area at the site of plaque rupture was similar in the both groups (2.44 +/- 1.34 mm(2) vs. 2.96 +/- 1.91 mm(2), p = 0.250), the area of ruptured cavity was significantly larger in STEMI compared with NSTEACS (2.52 +/- 1.36 mm(2) vs. 1.67 +/- 1.37 mm(2), p = 0.034). Furthermore, the ruptured plaque of which aperture was open-wide against the direction of coronary flow was more often seen in STEMI compared with NSTEACS (46% vs. 17%, p = 0.036).Conclusions The present OCT study demonstrated the differences of the culprit lesion morphologies between STEMI and NSTEACS. The morphological feature of plaque rupture and the intracoronary thrombus could relate to the clinical presentation in patients with acute coronary disease. (J Am Coll Cardiol Intv 2011;4:76-82) (C) 2011 by the American College of Cardiology Foundation