Department of Cardiovascular Medicine Fundacion Favaloro, and Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina.
Eur Heart J. 2009 Dec;30(23):2845-53. doi: 10.1093/eurheartj/ehp303. Epub 2009 Aug 7.
Vulnerable plaques in coronary arteries are frequently found in individuals who died suddenly or due to an acute coronary syndrome. The prevalence and characteristics of these plaques in the middle-aged apparently healthy population are unknown.
From a total of 652 hearts from transplant donors collected between 1996 and 2007, we selected those from apparently healthy individuals older than 40 years old who died of head trauma or stroke and had no evidence of prior vascular diseases. The coronary arteries were examined by serial sectioning at 3 mm intervals, and all areas of cross-sectional luminal narrowing were processed for histological, immunohistochemical, and morphometric studies. The atherosclerotic plaques were classified according to the American Heart Association Report. A total of 160 hearts were examined. Mean age was 50.3 +/- 5.8 years. Sixty-eight hearts had no advanced coronary atherosclerotic lesions (Type I, II, and III of the American Heart classification). In the remaining 92 hearts, we found 179 plaques considered high-risk lesions (American Heart Association Type IV, V, and VI). These plaques were more frequently found in males (P < 0.001) and in those with a higher heart weight (P < 0.001). The median (25th and 75th percentiles) vascular narrowing value using a planimetric analysis was 32% (21-53). No significant association with the cause of death was found (P = 0.09).
High-risk coronary artery plaques not associated with significant vascular lumen reduction exist in 57% of patients who suffered a brain death with a mean of 1.11 lesions prone to rupture per individual.
冠状动脉中的易损斑块常在猝死或急性冠脉综合征患者中发现。这些斑块在中年健康人群中的发生率和特征尚不清楚。
我们从 1996 年至 2007 年间收集的总共 652 例心脏移植供体中，选择了 40 岁以上因头部创伤或中风死亡且无先前血管疾病证据的健康个体的心脏。将冠状动脉进行 3mm 间隔的连续切片检查，并对所有横截面积管腔狭窄区域进行组织学、免疫组织化学和形态计量学研究。动脉粥样硬化斑块根据美国心脏协会报告进行分类。共检查了 160 颗心脏。平均年龄为 50.3 +/- 5.8 岁。68 颗心脏没有晚期冠状动脉粥样硬化病变（美国心脏协会分类的 I、II 和 III 型）。在其余 92 颗心脏中，我们发现了 179 个被认为是高危病变（美国心脏协会的 IV、V 和 VI 型）。这些斑块在男性中更常见（P < 0.001），并且在心脏重量较高的患者中更常见（P < 0.001）。使用平面分析的血管狭窄中位数（25%和 75%分位数）为 32%（21-53）。与死亡原因无显著相关性（P = 0.09）。
在平均每例 1.11 个易破裂病变的脑死亡患者中，57%存在与显著血管内腔减少无关的高危冠状动脉斑块。
