血管内镜确定的冠状动脉粥样硬化程度与急性冠状动脉综合征的严重程度相关。

Ueda Yasunori, Oyabu Jota, Okada Katsuki, Murakawa Tomokazu, Hirayama Atsushi, Kodama Kazuhisa

Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.

J Invasive Cardiol. 2006 May;18(5):220-4.

OBJECTIVE

Some patients with acute coronary syndrome (ACS) have large myocardial infarction but others have small or no infarction. However, what makes this difference has not been clarified. We compared the angioscopic findings between those two categories of ACS patients and examined the association between the severity of ACS and the morphology of both culprit lesion and nonculprit coronary segments.

METHODS

Prospectively and consecutively enrolled patients with ACS were classified as CK-elevation-ACS (CKE-ACS; n = 54) or non-CK-elevation-ACS (NCKE-ACS; n = 22). Patients were diagnosed as CKE-ACS when the elevation (greater than twice the normal upper limit) of CK-MB was detected; otherwise, patients were diagnosed as NCKE-ACS. They all underwent emergent catheterization and PCI of the culprit lesion. The entire culprit artery was observed by angioscopy, and the prevalence of thrombus and the color grade of yellow plaques were evaluated. The color grade of yellow plaques were classified as 0 (white), 1 (slight yellow), 2 (yellow), or 3 (intense yellow) according to the standard colors. The color grade of culprit plaque (CC), number (NP) and maximum (MC) color grade of yellow plaques in the nonculprit segments, plaque index (PI = N x MC), and prevalence of thrombus at the culprit lesion (CT) and in the nonculprit segments (NT) were compared between CKE-ACS and NCKE-ACS patients.

RESULTS

CC (1.9 +/- 0.9 vs. 1.7 +/- 0.8; p = 0.3) and CT (93% vs. 77%; p = 0.06) were not significantly different between CKE-ACS and NCKE-ACS patients, however, NP (2.2 +/- 1.6 vs. 1.4 +/- 1.2; p = 0.03), MC (1.8 +/- 0.9 vs. 1.2 +/- 0.9; p = 0.008), PI (4.8 +/- 4.4 vs. 2.4 +/- 3.1; p = 0.03), and NT (39% vs. 11%; p = 0.02) were significantly higher in CKE-ACS than in NCKE-ACS patients.

CONCLUSION

Although the culprit lesions of CKE- and NCKE-ACS had similar yellow color grades, the culprit lesions of CKE-ACS showed a trend towards a higher prevalence of thrombus. A greater number of yellow plaques of higher color grades and a higher prevalence of thrombosis in the nonculprit segments were detected in CKE-ACS compared to NCKE-ACS patients. The angioscopically-determined extent of coronary atherosclerosis appeared advanced in CKE-ACS patients compared to NCKE-ACS patients.

目的

一些急性冠状动脉综合征（ACS）患者发生大面积心肌梗死，而另一些患者梗死面积较小或无梗死。然而，造成这种差异的原因尚未明确。我们比较了这两类ACS患者的血管镜检查结果，并研究了ACS严重程度与罪犯病变及非罪犯冠状动脉节段形态之间的关联。

方法

前瞻性连续纳入的ACS患者被分为CK升高型ACS（CKE-ACS；n = 54）或非CK升高型ACS（NCKE-ACS；n = 22）。当检测到CK-MB升高（大于正常上限的两倍）时，患者被诊断为CKE-ACS；否则，患者被诊断为NCKE-ACS。他们均接受了罪犯病变的急诊导管插入术和经皮冠状动脉介入治疗（PCI）。通过血管镜观察整个罪犯动脉，评估血栓的发生率和黄色斑块的颜色分级。根据标准颜色，黄色斑块的颜色分级分为0（白色）、1（浅黄色）、2（黄色）或3（深黄色）。比较CKE-ACS和NCKE-ACS患者之间罪犯斑块的颜色分级（CC）、非罪犯节段黄色斑块的数量（NP）和最大颜色分级（MC）、斑块指数（PI = N×MC）以及罪犯病变处（CT）和非罪犯节段（NT）的血栓发生率。

结果

CKE-ACS和NCKE-ACS患者之间的CC（1.9±0.9对1.7±0.8；p = 0.3）和CT（93%对77%；p = 0.06）无显著差异，然而，CKE-ACS患者的NP（2.2±1.6对1.4±1.2；p = 0.03）、MC（1.8±0.9对1.2±0.9；p = 0.008）、PI（4.8±4.4对2.4±3.1；p = 0.03）和NT（39%对11%；p = 0.02）显著高于NCKE-ACS患者。

结论

尽管CKE-ACS和NCKE-ACS的罪犯病变黄色颜色分级相似，但CKE-ACS的罪犯病变血栓发生率有升高趋势。与NCKE-ACS患者相比，CKE-ACS患者非罪犯节段中颜色分级更高的黄色斑块数量更多，血栓形成发生率更高。与NCKE-ACS患者相比，血管镜确定的CKE-ACS患者冠状动脉粥样硬化程度似乎更严重。