First Department of Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-0813, Japan.
Eur Heart J. 2012 Jan;33(1):78-85. doi: 10.1093/eurheartj/ehr284. Epub 2011 Aug 10.
Morphological characteristics of non-significant coronary plaques (NSCPs) that develop rapid progression have not been fully elucidated. The aim of this study was to clarify the morphological characteristics of NSCPs in patients with coronary artery disease (CAD) using intravascular optical coherence tomography (OCT).
Fifty-three consecutive CAD patients undergoing percutaneous coronary intervention were enrolled and 69 NSCPs (per cent diameter stenosis <50%) were identified on baseline angiogram. Baseline characteristics of NSCPs were evaluated by OCT, and patients were followed-up prospectively. At the second coronary angiography, the baseline OCT characteristics and plaque progression were correlated. During the 7-month follow-up period, 13 NSCPs showed angiographic progression and 56 NSCPs did not. Baseline minimum lumen diameter and diametric stenosis were similar between NSCPs with and without progression. Compared with NSCPs without progression, those with progression showed a significantly higher incidence of intimal laceration (61.5 vs. 8.9%, P < 0.01), microchannel (76.9 vs. 14.3%, P < 0.01), lipid pools (100 vs. 60.7%, P = 0.02), thin-cap fibroatheroma (TCFA) (76.9 vs. 14.3%, P < 0.01), macrophage images (61.5 vs. 14.3%, P < 0.01), and intraluminal thrombi (30.8 vs. 1.8%, P < 0.01). Univariate regression analysis showed that TCFA and microchannel images showed high correlation with subsequent luminal progression [odds ratio (OR): 20.0, P < 0.01 and OR: 20.0, P < 0.01, respectively].
Optical coherence tomography-based complex characteristics of TCFA and microchannel were the potential predictors of subsequent progression of NSCPs in patients with CAD.
快速进展的非显著冠状动脉斑块（NSCP）的形态学特征尚未完全阐明。本研究旨在使用血管内光学相干断层扫描（OCT）阐明冠心病（CAD）患者的 NSCP 形态特征。
共纳入 53 例连续接受经皮冠状动脉介入治疗的 CAD 患者，根据基线血管造影，发现 69 个 NSCP（狭窄程度<50%）。通过 OCT 评估 NSCP 的基线特征，并对患者进行前瞻性随访。在第二次冠状动脉造影中，将基线 OCT 特征与斑块进展进行相关性分析。在 7 个月的随访期间，13 个 NSCP 显示血管造影进展，56 个 NSCP 没有进展。进展组与无进展组的 NSCP 最小管腔直径和直径狭窄程度相似。与无进展组相比，进展组的内膜撕裂（61.5%比 8.9%，P<0.01）、微通道（76.9%比 14.3%，P<0.01）、脂质池（100%比 60.7%，P=0.02）、薄帽纤维粥样斑块（TCFA）（76.9%比 14.3%，P<0.01）、巨噬细胞图像（61.5%比 14.3%，P<0.01）和腔内血栓（30.8%比 1.8%，P<0.01）的发生率明显更高。单因素回归分析显示，TCFA 和微通道图像与随后的管腔进展高度相关（优势比[OR]：20.0，P<0.01 和 OR：20.0，P<0.01）。
基于 OCT 的 TCFA 和微通道的复杂特征是 CAD 患者 NSCP 后续进展的潜在预测因子。
