Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
JACC Cardiovasc Interv. 2011 Jan;4(1):76-82. doi: 10.1016/j.jcin.2010.09.022.
The aim of this study was to investigate the difference of culprit lesion morphologies assessed by optical coherence tomography (OCT) between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTEACS).
Autopsy studies have reported that rupture of a thin-cap fibroatheroma and subsequent thrombus formation is the most important mechanism leading to acute coronary syndrome (ACS). Optical coherence tomography is a high-resolution imaging modality that is capable of investigating detailed coronary plaque morphology in vivo.
We examined the culprit lesion morphologies by OCT in 89 consecutive patients with acute coronary syndrome (STEMI = 40; NSTEACS = 49).
The incidence of plaque rupture, thin-cap fibroatheroma, and red thrombus was significantly higher in STEMI compared with NSTEACS (70% vs. 47%, p = 0.033, 78% vs. 49%, p = 0.008, and 78% vs. 27%, p < 0.001, respectively). Although the lumen area at the site of plaque rupture was similar in the both groups (2.44 ± 1.34 mm(2) vs. 2.96 ± 1.91 mm(2), p = 0.250), the area of ruptured cavity was significantly larger in STEMI compared with NSTEACS (2.52 ± 1.36 mm(2) vs. 1.67 ± 1.37 mm(2), p = 0.034). Furthermore, the ruptured plaque of which aperture was open-wide against the direction of coronary flow was more often seen in STEMI compared with NSTEACS (46% vs. 17%, p = 0.036).
The present OCT study demonstrated the differences of the culprit lesion morphologies between STEMI and NSTEACS. The morphological feature of plaque rupture and the intracoronary thrombus could relate to the clinical presentation in patients with acute coronary disease.
本研究旨在探讨光学相干断层扫描（OCT）评估的 ST 段抬高型心肌梗死（STEMI）与非 ST 段抬高型急性冠状动脉综合征（NSTEACS）罪犯病变形态学的差异。
尸检研究表明，薄帽纤维粥样斑块破裂和随后血栓形成是导致急性冠状动脉综合征（ACS）的最重要机制。光学相干断层扫描是一种高分辨率成像方式，能够活体研究详细的冠状动脉斑块形态学。
我们对 89 例急性冠状动脉综合征患者（STEMI = 40 例；NSTEACS = 49 例）进行了 OCT 检查。
STEMI 患者斑块破裂、薄帽纤维粥样斑块和红色血栓的发生率明显高于 NSTEACS（70%比 47%，p = 0.033；78%比 49%，p = 0.008；78%比 27%，p < 0.001）。虽然两组斑块破裂处的管腔面积相似（2.44 ± 1.34 mm²比 2.96 ± 1.91 mm²，p = 0.250），但 STEMI 患者破裂腔面积明显大于 NSTEACS（2.52 ± 1.36 mm²比 1.67 ± 1.37 mm²，p = 0.034）。此外，STEMI 患者中更常见到与冠状动脉血流方向相反的开放型破裂斑块（46%比 17%，p = 0.036）。
本研究显示了 STEMI 与 NSTEACS 之间罪犯病变形态学的差异。斑块破裂的形态特征和冠状动脉内血栓可能与急性冠状动脉疾病患者的临床表现有关。
