心血管危险因素对冠状动脉坏死核心的协同作用：来自全球血管内射频数据分析注册研究的报告

Synergistic effect of cardiovascular risk factors on necrotic core in coronary arteries: a report from the global intravascular radiofrequency data analysis registry.

作者信息

García-García Héctor M, Serruys Patrick W, Mintz Gary S, Saito Satoshi, Klaus Volker, Margolis Pauliina, Carlier Stephane, Goedhart Dick, Schwartz Robert

机构信息

Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.

出版信息

JACC Cardiovasc Imaging. 2009 May;2(5):629-36. doi: 10.1016/j.jcmg.2009.01.008.

DOI:10.1016/j.jcmg.2009.01.008

PMID:19442952

Abstract

OBJECTIVES

This study explored whether an individual or a cluster of risk factors affects the extent of necrotic core (NC) assessed by intravascular ultrasound (IVUS) radiofrequency data (RFD) analysis.

BACKGROUND

Several systemic diseases contribute to the development of coronary artery disease.

METHODS

The Global Intravascular Radiofrequency Data Analysis Registry was a prospective, multicenter, nonrandomized database that enrolled 990 patients with coronary artery disease in whom 1 major coronary artery was imaged by IVUS-RFD. For the multivariable analysis, the population was divided into 4 classes: young women, young men (both <or=62 years), old women, and old men (>62 years). Mean NC area was categorized as 1: top quartile (>or=0.62 mm(2)) or as 0: lower 3 quartiles.

RESULTS

Young patients had less NC compared with older patients (0.40 +/- 0.36 mm(2) of NC vs. 0.50 +/- 0.46 mm(2) in old patients, p = 0.0007). Nondiabetic patients had less NC than diabetic patients (0.43 +/- 0.41 mm(2) of NC vs. 0.51 +/- 0.44 mm(2) in diabetic patients, p = 0.02). The NC area was lower in normotensive patients (0.40 +/- 0.36 mm(2)) than in hypertensive patients (0.48 +/- 0.44 mm(2)) (p = 0.02). In the bivariate analysis, age, hypertension, diabetes, and prior coronary artery bypass graft were statistically significant, however in logistic regression analysis, only age (odds ratio [OR]: 1.023, 95% confidence interval [CI]: 1.009 to 1.037, p = 0.001) and diabetes (OR: 1.636, 95% CI: 1.174 to 2.279, p = 0.004) remained statistically significant. In a per-class logistic regression analyses including only diabetes as covariate, the OR in young women was 2.1 (95% CI: 0.77 to 6.0, p = 0.14), in young men the OR was 1.6 (95% CI: 0.90 to 2.7, p = 0.11), in old women the OR was 2.3 (95% CI: 1.09 to 4.9, p = 0.03), and in old men the OR was 1.6 (95% CI: 0.96 to 2.7, p = 0.07). Further, when only patients with diabetes and hypertension were included, young men (OR: 2.0, p = 0.041), old women (OR: 3.04, p = 0.046), and old men (OR: 2.2, p = 0.025) were significant.

CONCLUSIONS

Individually and collectively, age and diabetes mellitus are associated with an increase in NC by IVUS-RFD analysis.

摘要

目的

本研究探讨单个或一组危险因素是否会影响通过血管内超声（IVUS）射频数据（RFD）分析评估的坏死核心（NC）范围。

背景

多种全身性疾病促使冠状动脉疾病的发展。

方法

全球血管内射频数据分析注册库是一个前瞻性、多中心、非随机数据库，纳入了990例冠状动脉疾病患者，其中1支主要冠状动脉通过IVUS-RFD成像。对于多变量分析，将人群分为4类：年轻女性、年轻男性（均≤62岁）、老年女性和老年男性（>62岁）。平均NC面积分为1：上四分位数（≥0.62平方毫米）或0：下三个四分位数。

结果

与老年患者相比，年轻患者的NC较少（NC为0.40±0.36平方毫米，老年患者为0.50±0.46平方毫米，p = 0.0007）。非糖尿病患者的NC比糖尿病患者少（NC为0.43±0.41平方毫米，糖尿病患者为0.51±0.44平方毫米，p = 0.02）。血压正常患者的NC面积（0.40±0.36平方毫米）低于高血压患者（0.48±0.44平方毫米）（p = 0.02）。在双变量分析中，年龄、高血压、糖尿病和既往冠状动脉搭桥术具有统计学意义，然而在逻辑回归分析中，只有年龄（比值比[OR]：1.023，95%置信区间[CI]：1.009至1.037，p = 0.001）和糖尿病（OR：1.636，95%CI：1.174至2.279，p = 0.004）仍具有统计学意义。在仅将糖尿病作为协变量的各类逻辑回归分析中，年轻女性的OR为2.1（95%CI：0.77至6.0，p = 0.14），年轻男性的OR为1.6（95%CI：0.90至2.7，p = 0.11），老年女性的OR为2.3（95%CI：1.09至4.9，p = 0.03），老年男性的OR为1.6（95%CI：0.96至2.7，p = 0.07）。此外，当仅纳入患有糖尿病和高血压的患者时，年轻男性（OR：2.0，p = 0.041）、老年女性（OR：3.04，p = 0.046）和老年男性（OR：2.2，p = 0.025）具有统计学意义。