Department of Cardiology, Chubu-Rosai Hospital, Nagoya, Japan.
Circ J. 2011;75(2):383-90. doi: 10.1253/circj.cj-10-0815. Epub 2010 Dec 14.
Patients with acute coronary syndrome (ACS) have multiple complex coronary plaques associated with plaque vulnerability. The present study assessed the tissue characteristics of coronary plaques between ACS and stable angina pectoris (SAP) of culprit and non-culprit lesions using integrated backscatter intravascular ultrasound (IB-IVUS).
IVUS was performed in 165 patients (40 patients with ACS) with 225 culprit (65 lesions in ACS) and 171 non-culprit lesions (42 lesions in ACS). The percentage of fibrous area (fibrous area/plaque area, %FIB) and the percentage of lipid area (lipid area/plaque area, %LIP) at the segment with minimal luminal area were calculated using IB-IVUS system. Culprit and non-culprit lesions with ACS showed a significant increase in %LIP (38±18 vs. 30±15%, P=0.002, and 38±21 vs. 32±17%, P=0.03, respectively) and a significant decrease in %FIB (59±15 vs. 63±12 %, P=0.04, and 57±18 vs. 62±14%, P=0.04, respectively) compared to those with SAP. On logistic regression analysis, not only culprit lesions but also non-culprit lesions with ACS patients were significantly associated with the lipid-rich plaque.
Non-culprit coronary lesions with ACS patients are associated with the lipid-rich plaque, suggesting the extensive development of plaques instability in these patients.
急性冠状动脉综合征（ACS）患者存在多个与斑块易损性相关的复杂冠状动脉斑块。本研究采用背向散射积分（IB-IVUS）技术评估 ACS 和稳定性心绞痛（SAP）患者罪犯和非罪犯病变的斑块组织特征。
对 165 例患者（40 例 ACS）的 225 处罪犯病变（ACS 中 65 处病变）和 171 处非罪犯病变进行 IVUS 检查。使用 IB-IVUS 系统计算最小管腔面积节段的纤维面积百分比（纤维面积/斑块面积，%FIB）和脂质面积百分比（脂质面积/斑块面积，%LIP）。ACS 患者的罪犯和非罪犯病变的 %LIP 显著增加（38±18%比 30±15%，P=0.002，和 38±21%比 32±17%，P=0.03），%FIB 显著降低（59±15%比 63±12%，P=0.04，和 57±18%比 62±14%，P=0.04），与 SAP 患者相比。Logistic 回归分析显示，不仅是罪犯病变，ACS 患者的非罪犯病变也与富含脂质的斑块显著相关。
ACS 患者的非罪犯冠状动脉病变与富含脂质的斑块相关，提示这些患者斑块不稳定性广泛发展。
