Heart Research Center, Chonnam National University Hospital, Gwangju, Korea.
Am J Cardiol. 2010 Apr 1;105(7):936-42. doi: 10.1016/j.amjcard.2009.11.036.
We used intravascular ultrasonography to assess plaque morphology and morphometry in 310 patients with acute myocardial infarction (125 with ST-segment elevation and 185 with non-ST-segment elevation myocardial infarction) with varying degrees of renal dysfunction according to the creatinine clearance (CrCl): CrCl >70 ml/min in 153, CrCl of 30 to 69 ml/min in 103, and CrCl of <30 ml/min in 54 patients, including 20 patients requiring dialysis). The lesion site plaque burden was greatest (77.4 +/- 11.0% vs 79.8 +/- 12.5% vs 82.0 +/- 10.3%, p = 0.031) and the lesion was longest (20.9 +/- 9.1 vs 23.1 +/- 9.5 vs 26.3 +/- 9.6 mm, p = 0.038) in the lowest CrCl group. Infarct-related artery plaque rupture (31.4% vs 34.0% vs 53.7%, p = 0.011) and multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p <0.001) were the most common, the ruptured plaque cavities were the largest (1.98 +/- 0.89 vs 2.20 +/- 1.45 vs 3.06 +/- 1.70 mm(2), p = 0.002), and the ruptured plaque was longest (2.33 +/- 0.93 vs 2.59 +/- 1.50 vs 3.33 +/- 1.76 mm, p = 0.008) in the lowest CrCl group (<30 ml/min). Intravascular ultrasound-detected thrombus was observed most frequently in the lowest CrCl group (22.9% vs 23.3% vs 40.7%, p = 0.027). CrCl was the one of the independent predictors of culprit lesion plaque rupture (odds ratio 0.979, 95% confidence interval 0.963 to 0.994, p = 0.008). During 1 year of follow-up, the incidence of nonfatal myocardial infarction (2.6% vs 4.9% vs 11.1%, p = 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p = 0.024) was greatest in the lowest CrCl group. Also, a strong trend was found toward the greatest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p = 0.057) in the lowest CrCl group. In conclusion, patients with acute myocardial infarction and significant renal dysfunction had more plaque vulnerability compared to those with normal renal function. This might be associated with poor clinical outcomes in patients with acute myocardial infarction and renal dysfunction.
我们使用血管内超声评估了 310 例急性心肌梗死患者（125 例 ST 段抬高型心肌梗死，185 例非 ST 段抬高型心肌梗死）的斑块形态和形态计量学，这些患者的肾功能不全程度不同，根据肌酐清除率（CrCl）分为三组：CrCl>70ml/min 者 153 例，CrCl 为 30-69ml/min 者 103 例，CrCl<30ml/min 者 54 例，其中包括 20 例需要透析的患者）。最低 CrCl 组的病变部位斑块负荷最大（77.4%±11.0%比 79.8%±12.5%比 82.0%±10.3%，p=0.031），病变最长（20.9%±9.1%比 23.1%±9.5%比 26.3%±9.6mm，p=0.038）。最低 CrCl 组中梗死相关动脉斑块破裂（31.4%比 34.0%比 53.7%，p=0.011）和多发性斑块破裂（11.1%比 12.6%比 33.3%，p<0.001）最为常见，破裂斑块的腔最大（1.98±0.89mm2比 2.20±1.45mm2比 3.06±1.70mm2，p=0.002），破裂斑块最长（2.33±0.93mm 比 2.59±1.50mm 比 3.33±1.76mm，p=0.008）。最低 CrCl 组（<30ml/min）最常观察到血管内超声检测到的血栓（22.9%比 23.3%比 40.7%，p=0.027）。CrCl 是罪犯病变斑块破裂的独立预测因素之一（比值比 0.979，95%置信区间 0.963-0.994，p=0.008）。在 1 年的随访中，最低 CrCl 组的非致命性心肌梗死（2.6%比 4.9%比 11.1%，p=0.044）和心脏死亡（3.9%比 6.8%比 14.8%，p=0.024）发生率最高。此外，最低 CrCl 组支架血栓形成的发生率也呈现出最大的趋势（2.0%比 3.9%比 9.3%，p=0.057）。总之，与肾功能正常的患者相比，急性心肌梗死合并严重肾功能不全的患者斑块更脆弱，这可能与急性心肌梗死合并肾功能不全患者的不良临床结局有关。
