Department of Cardiology, Tsuchiura Kyodo Hospital, 11-7 Manabeshin-machi, Tsuchiura, Ibaraki, Japan.
Eur Heart J. 2011 May;32(10):1251-9. doi: 10.1093/eurheartj/ehq518. Epub 2011 Jan 27.
The widely accepted threshold of <65 μm for coronary plaque fibrous cap thickness was derived from postmortem studies of ruptured plaques and may not be appropriate for in vivo rupture-prone plaques. We investigated the relationship between fibrous cap thickness and plaque rupture using optical coherence tomography (OCT).
We studied 266 lesions (103 from patients with acute coronary syndrome and 163 from patients with stable angina) before percutaneous coronary intervention using OCT. Ruptured and non-ruptured lipid-rich plaques were identified and the thinnest and most representative fibrous cap thickness were determined. Cap thickness was reliably measured in 71 ruptured and 111 non-ruptured plaques. From the ruptured plaques, the median thinnest cap thickness was 54 μm (50-60). The median most representative cap thickness was 116 μm (103-136). For non-ruptured plaques, the median thinnest cap thickness was 80 μm (67-104) and 182 μm (156-216) for most representative cap thickness. In 95% of ruptured plaques, the thinnest cap thickness and most representative cap thickness were <80 and <188 μm, respectively. The best cut-offs for predicting rupture were <67 μm (OR: 16.1, CI: 7.5-34.4, P < 0.001) for the thinnest cap thickness and <151 μm (OR: 35.6, CI: 15.0-84.3, P < 0.001) for most representative cap thickness. These two measures were modestly correlated (r(2) = 0.39) and both independently associated with rupture.
In vivo critical cap thicknesses were <80 μm for the thinnest and <188 μm for most representative fibrous cap thickness. Prospective imaging studies are required to establish the significance of these values.
<65μm 的冠状动脉斑块纤维帽厚度被广泛认为是破裂斑块的尸检研究得出的阈值，可能并不适用于易发生破裂的活体斑块。我们使用光学相干断层扫描（OCT）研究了纤维帽厚度与斑块破裂之间的关系。
我们在经皮冠状动脉介入治疗前使用 OCT 研究了 266 个病变（103 个来自急性冠状动脉综合征患者，163 个来自稳定型心绞痛患者）。识别出破裂和非破裂的富含脂质的斑块，并确定了最薄和最具代表性的纤维帽厚度。可靠地测量了 71 个破裂和 111 个非破裂斑块的帽厚度。从破裂的斑块中，最薄的帽厚度中位数为 54μm（50-60）。最具代表性的帽厚度中位数为 116μm（103-136）。对于非破裂斑块，最薄的帽厚度中位数为 80μm（67-104），最具代表性的帽厚度中位数为 182μm（156-216）。在 95%的破裂斑块中，最薄的帽厚度和最具代表性的帽厚度均<80μm 和<188μm。预测破裂的最佳截断值为最薄帽厚度<67μm（OR：16.1，95%CI：7.5-34.4，P<0.001）和最具代表性帽厚度<151μm（OR：35.6，95%CI：15.0-84.3，P<0.001）。这两个指标中度相关（r(2)=0.39），且均可独立与破裂相关。
活体临界帽厚度最薄处<80μm，最具代表性处<188μm。需要前瞻性成像研究来确定这些值的意义。
