Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
JACC Cardiovasc Imaging. 2011 Aug;4(8):894-901. doi: 10.1016/j.jcmg.2011.05.005.
The purpose of this study was to determine whether thin-capped fibroatheromata (TCFA) identified by virtual histology intravascular ultrasound (VH-IVUS) are associated with major adverse cardiac events (MACE) on individual plaque or whole patient analysis.
Post-mortem studies have identified TCFA as the substrate for most myocardial infarctions. However, little is known about the natural history of individual TCFA and their link with MACE. VH-IVUS provides a method of identifying plaques in vivo that are similar (although not identical) to histologically defined TCFA, and has been validated in human atherectomy and post-mortem studies.
One hundred seventy patients with stable angina or troponin-positive acute coronary syndrome referred for percutaneous coronary intervention (PCI) were prospectively enrolled and underwent 3-vessel VH-IVUS pre-PCI and also post-PCI in the culprit vessel. MACE consisted of death, myocardial infarction, or unplanned revascularization.
In all, 30,372 mm of VH-IVUS were analyzed. Eighteen MACE occurred in 16 patients over a median follow-up of 625 days (interquartile range: 463 to 990 days); 1,096 plaques were classified, and 19 lesions resulted in MACE (13 nonculprit lesions and 6 culprit lesions). Nonculprit lesion factors associated with nonrestenotic MACE included VHTCFA (hazard ratio [HR]: 7.53, p = 0.038) and plaque burden >70% (HR: 8.13, p = 0.011). VHTCFA (HR: 8.16, p = 0.007), plaque burden >70% (HR: 7.48, p < 0.001), and minimum luminal area <4 mm(2) (HR: 2.91, p = 0.036) were associated with total MACE. On patient-based analysis, the only factor associated with nonrestenotic MACE was 3-vessel noncalcified VHTCFA (HR: 1.79, p = 0.004).
VH-IVUS TCFA was associated with nonrestenotic and total MACE on individual plaque analysis, and noncalcified VHTCFA was associated with nonrestenotic and total MACE on whole-patient analysis, demonstrating that VH-IVUS can identify plaques at increased risk of subsequent events. The preservation of the association between VHTCFA and MACE despite various analyses emphasizes its biological importance.
本研究旨在确定通过虚拟组织学血管内超声（VH-IVUS）识别的薄帽纤维粥样斑块（TCFA）是否与个体斑块或整体患者分析的主要不良心脏事件（MACE）相关。
尸检研究已将 TCFA 确定为大多数心肌梗死的病变基础。然而，对于个体 TCFA 的自然史及其与 MACE 的联系知之甚少。VH-IVUS 提供了一种在体内识别斑块的方法，这些斑块与组织学定义的 TCFA 相似（尽管不完全相同），并且已经在人类血管成形术和尸检研究中得到验证。
170 名稳定型心绞痛或肌钙蛋白阳性急性冠状动脉综合征患者接受经皮冠状动脉介入治疗（PCI），前瞻性入组并在 PCI 前进行 3 支血管 VH-IVUS 检查，以及在罪犯血管中进行 PCI 后检查。MACE 包括死亡、心肌梗死或计划外血运重建。
共分析了 30372 毫米的 VH-IVUS。在中位随访 625 天（四分位距：463 至 990 天）期间，16 名患者发生了 18 例 MACE；共分类了 1096 个斑块，19 个病变导致 MACE（13 个非罪犯病变和 6 个罪犯病变）。与非再狭窄性 MACE 相关的非罪犯病变因素包括 VH-TCFA（危险比 [HR]：7.53，p = 0.038）和斑块负荷>70%（HR：8.13，p = 0.011）。VH-TCFA（HR：8.16，p = 0.007）、斑块负荷>70%（HR：7.48，p < 0.001）和最小管腔面积<4mm2（HR：2.91，p = 0.036）与总 MACE 相关。基于患者的分析，唯一与非再狭窄性 MACE 相关的因素是非钙化的 3 支血管 VH-TCFA（HR：1.79，p = 0.004）。
VH-IVUS TCFA 与个体斑块分析中的非再狭窄性和总 MACE 相关，非钙化的 VH-TCFA 与整体患者分析中的非再狭窄性和总 MACE 相关，表明 VH-IVUS 可识别具有后续事件风险的斑块。尽管进行了各种分析，但 VH-TCFA 与 MACE 之间的关联仍然存在，这强调了其生物学重要性。
