Department of Vascular Surgery, Experimental Cardiology Laboratory, University Medical Center Utrecht, Heidelberglaan 100, Suite G02.523, 3584CX Utrecht, the Netherlands.
Circulation. 2010 May 4;121(17):1941-50. doi: 10.1161/CIRCULATIONAHA.109.887497. Epub 2010 Apr 19.
Identification of patients at risk for primary and secondary manifestations of atherosclerotic disease progression is based mainly on established risk factors. The atherosclerotic plaque composition is thought to be an important determinant of acute cardiovascular events, but no prospective studies have been performed. The objective of the present study was to investigate whether atherosclerotic plaque composition is associated with the occurrence of future vascular events.
Atherosclerotic carotid lesions were collected from patients who underwent carotid endarterectomy and were subjected to histological examination. Patients underwent clinical follow-up yearly, up to 3 years after carotid endarterectomy. The primary outcome was defined as the composite of a vascular event (vascular death, nonfatal stroke, nonfatal myocardial infarction) and vascular intervention. The cumulative event rate at 1-, 2-, and 3-year follow-up was expressed by Kaplan-Meier estimates, and Cox proportional hazards regression analyses were performed to assess the independence of histological characteristics from general cardiovascular risk factors. During a mean follow-up of 2.3 years, 196 of 818 patients (24%) reached the primary outcome. Patients whose excised carotid plaque revealed plaque hemorrhage or marked intraplaque vessel formation demonstrated an increased risk of primary outcome (risk difference=30.6% versus 17.2%; hazard ratio [HR] with [95% confidence interval]=1.7 [1.2 to 2.5]; and risk difference=30.0% versus 23.8%; HR=1.4 [1.1 to 1.9], respectively). Macrophage infiltration (HR=1.1 [0.8 to 1.5]), large lipid core (HR=1.1 [0.7 to 1.6]), calcifications (HR=1.1 [0.8 to 1.5]), collagen (HR=0.9 [0.7 to 1.3]), and smooth muscle cell infiltration (HR=1.3 [0.9 to 1.8]) were not associated with clinical outcome. Local plaque hemorrhage and increased intraplaque vessel formation were independently related to clinical outcome and were independent of clinical risk factors and medication use.
The local atherosclerotic plaque composition in patients undergoing carotid endarterectomy is an independent predictor of future cardiovascular events.
识别发生动脉粥样硬化疾病进展的原发性和继发性表现的患者主要基于已确立的风险因素。动脉粥样硬化斑块成分被认为是急性心血管事件的重要决定因素，但尚未进行前瞻性研究。本研究的目的是探讨动脉粥样硬化斑块成分是否与未来血管事件的发生有关。
从接受颈动脉内膜切除术并接受组织学检查的患者中收集动脉粥样硬化颈动脉病变。患者在颈动脉内膜切除术 1 年后每年接受临床随访，最长随访 3 年。主要结局定义为血管事件（血管死亡、非致死性中风、非致死性心肌梗死）和血管介入的复合事件。通过 Kaplan-Meier 估计表达 1 年、2 年和 3 年随访的累积事件率，并进行 Cox 比例风险回归分析，以评估组织学特征与一般心血管危险因素的独立性。在平均 2.3 年的随访期间，818 例患者中有 196 例（24%）达到了主要结局。切除的颈动脉斑块显示斑块出血或明显斑块内血管形成的患者发生主要结局的风险增加（风险差异=30.6%比 17.2%；风险比[95%置信区间]为 1.7[1.2 至 2.5]；风险差异=30.0%比 23.8%；风险比=1.4[1.1 至 1.9]）。巨噬细胞浸润（HR=1.1[0.8 至 1.5]）、大脂质核心（HR=1.1[0.7 至 1.6]）、钙化（HR=1.1[0.8 至 1.5]）、胶原（HR=0.9[0.7 至 1.3]）和平滑肌细胞浸润（HR=1.3[0.9 至 1.8]）与临床结局无关。局部斑块出血和斑块内血管形成增加与临床结局独立相关，与临床危险因素和药物使用无关。
颈动脉内膜切除术后患者的局部动脉粥样硬化斑块成分是未来心血管事件的独立预测因子。
