Echolucent carotid plaques predict future coronary events in patients with coronary artery disease
Echolucent carotid plaques predict future coronary events in patients with coronary artery disease
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DOI：
10.1016/j.jacc.2003.09.063
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发表时间：
2004-04-07
影响因子：
24
通讯作者：
Ogawa, H
中科院分区：
文献类型：
--
作者：
Honda, O;Sugiyama, S;Ogawa, H
本研究的目的是检查回声颈动脉斑块是否可预测临床稳定型冠状动脉疾病（CAD）患者未来的冠状动脉事件。背景虽然冠状动脉斑块破裂被认为是急性冠状动脉综合征（ACS）的主要原因，但冠状动脉易损性的临床评估仍然没有定论。利用背向散射积分（IBS）分析对颈动脉斑块进行超声评价可以指示斑块的一致性/结构。富含脂质的病变被称为“不稳定斑块”出现回声斑块与低IBS值using this technique.METHODS我们调查了回声回声的颈动脉斑块使用超声IBS在286个连续的CAD患者（71 ACS和215稳定CAD）。结果ACS患者颈动脉斑块IBS校正值明显低于稳定期CAD患者（P <0.01），而稳定期CAD患者斑块IBS校正值明显低于稳定期CAD患者（P < 0.01）。回声颈动脉斑块准确预测复杂冠状动脉斑块的存在（预测能力为83%）。Kaplan-Meier分析显示，有回声斑块的患者发生冠状动脉事件的概率显著高于无回声斑块的患者（p < 0.001）。稳定型CAD患者存在回声颈动脉斑块可预测未来的冠状动脉事件，与其他危险因素无关（优势比7.0，95%置信区间2.3至21.4; p < 0.001）。结论：IBS值低的回声颈动脉斑块可预测稳定型CAD患者冠状动脉斑块的复杂性和未来冠状动脉并发症的发生。使用IBS超声定性评价颈动脉斑块是CAD患者风险评估的临床有用程序。(C)2004年，美国心脏病学会基金会。
OBJECTIVES The purpose of this study was to examine whether echolucent carotid plaques predict future coronary events in patients with clinically stable coronary artery disease (CAD).BACKGROUND Although rupture of coronary plaques is considered a major cause of acute coronary syndromes (ACS), the clinical estimation of coronary vulnerability still remains inconclusive. Ultrasound evaluation of carotid plaques with integrated backscatter (IBS) analysis can indicate the consistency/structure of the plaques. Lipid-rich lesions known as "unstable plaques" appear as echolucent plaques with low IBS values using this technique.METHODS We investigated the echogenicity of carotid plaques using ultrasound with IBS in 286 consecutive CAD patients (71 with ACS and 215 with stable CAD). Coronary plaque complexity was also determined angiographically in stable CAD patients followed up for 30 months or until the occurrence of coronary events.RESULTS The calibrated IBS values of carotid plaques in ACS patients were significantly lower than those in stable CAD patients (p < 0.01). Echolucent carotid plaques accurately predicted the existence of complex coronary plaques (predictive power of 83%). Kaplan-Meier analysis demonstrated a significantly higher probability of coronary events developing in patients with echolucent carotid plaques than in patients without this type of plaque (p < 0.001). The presence of echolucent carotid plaques in stable CAD patients predicted future coronary events independent of other risk factors (odds ratio 7.0, 95% confidence interval 2.3 to 21.4; p < 0.001).CONCLUSIONS Echolucent carotid plaques with low IBS values predicted coronary plaque complexity and the development of future coronary complications in patients with stable CAD. Qualitative evaluation of carotid plaques using ultrasound with IBS is a clinically useful procedure for risk assessment of CAD patients. (C) 2004 by the American College of Cardiology Foundation.