First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
JACC Cardiovasc Interv. 2010 May;3(5):507-14. doi: 10.1016/j.jcin.2010.02.010.
This study investigated the association between morphological characteristics of culprit atheromatic lesions as assessed by optical coherence tomography and Thrombolysis In Myocardial Infarction (TIMI) flow grade after thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI).
Although several variables have been found to predict coronary flow after thrombolysis in patients with STEMI, the impact of culprit lesion morphology has not been studied.
Fifty-five patients with STEMI from 3 tertiary centers that were treated with thrombolysis and underwent optical coherence tomography examination in the culprit lesion between 24 and 48 h after thrombolysis were included in the study. Patients were categorized on the basis of TIMI flow grade into patients with TIMI flow grade 3 versus TIMI flow grade < or =2.
Patients with TIMI flow grade < or =2 had plaques with more lipid quadrants than patients with TIMI flow grade 3 (p < 0.001), and presented with greater incidence of plaque rupture (p = 0.001). Mean minimal cap thickness was greater in patients with patent arteries than in patients with impaired flow (87 +/- 26 microm vs. 48 +/- 18 microm, p < 0.0001). Minimal cap thickness was independently associated with TIMI flow grade.
The morphological characteristics of the culprit atheromatic lesion in patients with STEMI are associated with coronary flow after thrombolysis. The lipid content, the existence of rupture, and mainly the thickness of the fibrous cap are associated with the outcome of thrombolysis.
本研究通过光学相干断层扫描（OCT）评估罪犯动脉粥样硬化病变的形态学特征与 ST 段抬高型心肌梗死（STEMI）患者溶栓后 TIMI 血流分级之间的关系。
尽管已经发现了几个可预测 STEMI 患者溶栓后冠状动脉血流的变量，但罪犯病变形态的影响尚未得到研究。
研究纳入了 3 家三级中心的 55 例 STEMI 患者，这些患者在溶栓后 24 至 48 小时内行罪犯病变 OCT 检查。根据 TIMI 血流分级将患者分为 TIMI 血流分级 3 级与 TIMI 血流分级<或=2 级两组。
TIMI 血流分级<或=2 级的患者斑块中脂质象限多于 TIMI 血流分级 3 级的患者（p<0.001），斑块破裂的发生率也更高（p=0.001）。与血流受损的患者相比，血管通畅的患者的最小帽厚度更大（87+/-26μm 比 48+/-18μm，p<0.0001）。最小帽厚度与 TIMI 血流分级独立相关。
STEMI 患者罪犯动脉粥样硬化病变的形态学特征与溶栓后的冠状动脉血流有关。脂质含量、破裂的存在以及主要是纤维帽的厚度与溶栓的结果有关。
