Wang Zhi-Guo, Gai Lu-Yue, Gai Jing-Jing, Li Ping, Yang Xia, Jin Qin-Hua, Chen Yun-Dai, Sun Zhi-Jun, Guan Zhi-Wei
Department of Cardiology, The General Hospital of the People's Liberation Army, Beijing 100853, China.
Chin Med Sci J. 2011 Jun;26(2):85-90. doi: 10.1016/s1001-9294(11)60025-4.
To determine if multi-detector CT (MDCT) characterization of plaque is correlated with the classification of acute coronary syndrome (ACS).
Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group ( n=61) and diffuse plaque group ( n=34) based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and remodeling index. The incidences of major adverse cardiac events in follow-up period were also recorded.
The patients of the diffuse plaque group were older than those of the discrete plaque group ( Pü0.0001). The diffuse plaque group presented more cases of hypertension, peripheral artery disease, diabetes, and heart failure than discrete plaque group (all P<0.05). All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group(5.15±3.55 vs. 14.91±5.37, Pü0.001). The other four scores demonstrated significant inter-group difference as well (all P<0.05). The remodeling index of thediscrete plaque group was higher (1.12±0.16 vs.0.97±0.20, Pü0.05). Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group (29.41% vs. 11.48%, P=0.0288).
Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.
确定多排螺旋CT（MDCT）对斑块的特征描述是否与急性冠状动脉综合征（ACS）的分类相关。
2007年12月至2009年5月期间，共有1900例患者接受了MDCT检查，其中95例符合ACS标准。根据MDCT检查结果，将这些患者分为离散斑块组（n = 61）和弥漫性斑块组（n = 34）。分析ACS的临床诊断和CT结果，包括节段狭窄评分、节段累及评分、三支血管斑块评分、左主干评分、钙化评分和重构指数。还记录了随访期间主要不良心脏事件的发生率。
弥漫性斑块组患者比离散斑块组患者年龄更大（P<0.0001）。弥漫性斑块组高血压、外周动脉疾病、糖尿病和心力衰竭的病例比离散斑块组更多（均P<0.05）。所有5例ST段抬高型心肌梗死患者均在离散斑块组中发现。离散斑块组的节段狭窄评分低于弥漫性斑块组（5.15±3.55对14.91±5.37，P<0.001）。其他四项评分也显示出显著的组间差异（均P<0.05）。离散斑块组的重构指数更高（1.12±0.16对0.97±0.20，P<0.05）。随访数据显示，弥漫性斑块组主要不良心脏事件的发生率高于离散组（29.41%对11.48%，P = 0.0288）。
不同类型的ACS中，离散斑块和弥漫性斑块的特征可能存在显著差异。弥漫性斑块可能具有更高的风险，与更高的死亡率相关。通过MDCT诊断离散斑块和弥漫性斑块将为ACS的预后和治疗提供新的见解。
