冠状动脉疾病患者虚拟组织学-血管内超声检查结果的年龄相关性差异。

Age-related differences in virtual histology-intravascular ultrasound findings in patients with coronary artery disease.

机构信息

Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea.

出版信息

J Cardiol. 2010 Mar;55(2):224-31. doi: 10.1016/j.jjcc.2009.11.004. Epub 2010 Jan 14.

DOI:10.1016/j.jjcc.2009.11.004

PMID:20206076

Abstract

BACKGROUND

We assessed the age-related differences in pre-intervention virtual histology-intravascular ultrasound (VH-IVUS) findings at target lesion sites in patients with coronary artery disease.

METHODS

A total of 553 patients who underwent pre-intervention VH-IVUS imaging were grouped according to age: non-elderly (< or = 70 years, n=429) and elderly (>70 years, n=124); 191 had stable angina and 362 acute coronary syndrome. VH-IVUS classified the tissue into: fibrotic, fibro-fatty, dense calcium (DC), and necrotic core (NC).

RESULTS

Overall, the absolute and percent volumes of DC (11.0 + or - 11.0mm(3) vs. 9.7 + or - 11.9 mm(3), P=0.033; 11.7 + or - 8.1% vs. 9.8 + or - 7.2%, P=0.014, respectively) and NC (18.5 + or - 17.6mm(3) vs. 16.6 + or - 18.9 mm(3), P=0.020; 18.8 + or - 8.8% vs. 16.5 + or - 9.3%, P=0.026, respectively) were significantly greater in the elderly than in the non-elderly. In stable angina patients, the absolute and percent volumes of DC (10.4 + or - 9.9 mm(3) vs. 7.2 + or - 7.6 mm(3), P=0.022; 13.4 + or - 10.0% vs. 9.2 + or - 6.5%, P=0.011, respectively) and NC (14.8 + or - 11.2 mm(3) vs. 12.0 + or - 11.9 mm(3), P=0.035; 19.6 + or - 8.8% vs. 15.5 + or - 8.4%, P=0.006, respectively) were significantly greater in the elderly. However, in acute coronary syndrome patients, there were no significant differences in absolute and percent volumes of DC (11.4 + or - 11.6 mm(3) vs. 10.9 + or - 13.4 mm(3), P=0.8; 10.7 + or - 6.5% vs. 10.1 + or - 7.5%, P=0.5, respectively) and NC (24.1 + or - 20.3 mm(3) vs. 23.9 + or - 21.2 mm(3), P=0.9; 22.0 + or - 8.8% vs. 21.3 + or - 9.6%, P=0.6, respectively) between the elderly and non-elderly groups. Myocardial infarction (OR: 2.56, 95% CI: 1.45-4.12, P=0.003), diabetes mellitus (OR: 2.23, 95% CI: 1.30-3.53, P=0.009), and high-sensitivity C-reactive protein (OR: 1.44, 95% CI: 1.06-2.45, P=0.042), but not age, were independent predictors of percent NC volume >20% in lesion site.

CONCLUSIONS

Myocardial infarction, diabetes mellitus, and high-sensitivity C-reactive protein, but not age, were associated with NC-rich lesions. Clinical presentation, risk factors, and inflammatory status, but not age, are important factors for plaque components.

摘要

背景

我们评估了冠状动脉疾病患者靶病变部位血管内超声（IVUS）检查的年龄相关性差异。

方法

553 例接受术前 IVUS 成像的患者根据年龄分为两组：非老年组（≤70 岁，n=429）和老年组（>70 岁，n=124）；其中 191 例为稳定性心绞痛，362 例为急性冠脉综合征。IVUS 将组织分为纤维、纤维脂肪、致密钙（DC）和坏死核（NC）。

结果

总体而言，老年组的 DC（11.0±11.0mm³比 9.7±11.9mm³，P=0.033）和 NC（18.5±17.6mm³比 16.6±18.9mm³，P=0.020）的绝对和百分比体积明显大于非老年组；在稳定性心绞痛患者中，老年组的 DC（10.4±9.9mm³比 7.2±7.6mm³，P=0.022）和 NC（14.8±11.2mm³比 12.0±11.9mm³，P=0.035）的绝对和百分比体积也明显大于非老年组；然而，在急性冠脉综合征患者中，DC（11.4±11.6mm³比 10.9±13.4mm³，P=0.8）和 NC（24.1±20.3mm³比 23.9±21.2mm³，P=0.9）的绝对和百分比体积在老年组和非老年组之间无显著差异。心肌梗死（OR：2.56，95%CI：1.45-4.12，P=0.003）、糖尿病（OR：2.23，95%CI：1.30-3.53，P=0.009）和高敏 C 反应蛋白（OR：1.44，95%CI：1.06-2.45，P=0.042），但不是年龄，是病变部位 NC 体积百分比>20%的独立预测因子。