Hong Myeong-Ki, Mintz Gary S, Lee Cheol Whan, Suh Jon, Kim Jeong-Hoon, Park Duk-Woo, Lee Seung-Whan, Kim Young-Hak, Cheong Sang-Sig, Kim Jae-Joong, Park Seong-Wook, Park Seung-Jung
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2007 Sep 15;100(6):953-9. doi: 10.1016/j.amjcard.2007.04.034. Epub 2007 Jun 29.
Coronary plaque composition cannot be assessed accurately using gray-scale intravascular ultrasound (IVUS). Using virtual histology IVUS (VH-IVUS), a comparison of coronary plaque composition between acute coronary syndromes (ACS) and stable angina pectoris (SAP) was performed. Preintervention IVUS of de novo culprit and target lesions was performed in 318 patients (123 with ACS and 195 with SAP). Using VH-IVUS, plaque was characterized as fibrotic, fibrofatty, dense calcium, and necrotic core. VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) was defined as necrotic core>or=10% of plaque area without overlying fibrous tissue in a plaque burden>or=40%. Lesions were classified into 3 groups: ruptured, VH-TCFA, and non-VH-TCFA plaque. Unstable lesions were defined as either VH-TCFA or ruptured plaque. Compared with patients with SAP, those with ACS had significantly more unstable lesions (89% vs 62%, p<0.001). Planar VH-IVUS analysis at the minimum luminal site and at the largest necrotic core site and volumetric analysis over a 10-mm-long segment centered at the minimum luminal site showed that the percentage of necrotic core was significantly greater and that the percentage of fibrofatty plaque was significantly smaller in patients with ACS. The percentages of fibrotic and fibrofatty plaque areas and volumes were smaller, and the percentages of necrotic core areas and volumes were larger in VH-TCFAs compared with non-TCFAs. Ruptured plaques in VH-IVUS analyses showed intermediate findings between VH-TCFAs and non-VH-TCFAs. In conclusion, culprit lesions in patients with ACS were more unstable and had greater amounts of necrotic core and smaller amounts of fibrofatty plaque compared with target lesions in patients with SAP.
使用灰阶血管内超声（IVUS）无法准确评估冠状动脉斑块成分。采用虚拟组织学IVUS（VH-IVUS），对急性冠状动脉综合征（ACS）和稳定型心绞痛（SAP）患者的冠状动脉斑块成分进行了比较。对318例患者（123例ACS患者和195例SAP患者）的初发罪犯病变和靶病变进行了干预前IVUS检查。使用VH-IVUS，将斑块分为纤维性、纤维脂肪性、致密钙化性和坏死核心性。VH-IVUS衍生的薄帽纤维粥样斑块（VH-TCFA）定义为坏死核心占斑块面积≥10%，且斑块负荷≥40%时无覆盖纤维组织。病变分为3组：破裂斑块、VH-TCFA斑块和非VH-TCFA斑块。不稳定病变定义为VH-TCFA或破裂斑块。与SAP患者相比，ACS患者的不稳定病变明显更多（89%对62%，p<0.001）。在最小管腔部位和最大坏死核心部位进行的平面VH-IVUS分析以及以最小管腔部位为中心的10毫米长节段的容积分析显示，ACS患者的坏死核心百分比明显更高，纤维脂肪斑块百分比明显更小。与非TCFA相比，VH-TCFA中纤维性和纤维脂肪斑块面积及容积的百分比更小，坏死核心面积及容积的百分比更大。VH-IVUS分析中的破裂斑块显示出介于VH-TCFA和非VH-TCFA之间的中间结果。总之，与SAP患者的靶病变相比，ACS患者的罪犯病变更不稳定，坏死核心量更大，纤维脂肪斑块量更小。
